On Bullshit Psychology

The Bullshit Psychology Stamp of Disapproval I was going to write this post on ” pop psychology ” but decided that moniker just doesn’t cut it, and the scope is too limited and easy.  What we are referring to when we say “pop psychology” is 99% bullshit.  Not too hard to see that, if you read 50 of those books and your life still sucks .  But for that matter, what passes for “evidence-based” psychology is still probably at least 60% bullshit.  I’m going to go beyond bashing the obvious targets that lard up our bookshelves, the self-help books and so forth.  I want to target much of what clinical psychology that the public encounters eagerly defines itself as.  It’s not “popular” necessarily, but it is awfully self-important and mostly wrong and potentially damaging to the public.  Actually, So let’s call it what it is: Bullshit psychology.

The main premise of bullshit psychology is that there is something wrong with you, and you need psychology to fix what’s wrong with you.  This is the first premise of bullshit.  I want to highlight this premise because all else in bullshit psychology rests on it.  You are broken, we will fix you.  We, the experts, will provide you the information to fix yourself.  Bullshit.

The Universal, Ubiquitous Doctrine of Bullshit Psychology

One difficulty I run into as a therapist is that, by the time people get to my office, they are already inculcated with bullshit.  They believe bullshit ardently.  “I am broken.  I have something wrong with me.  You are an expert and you will fix me.”  It would probably be both rude and counterproductive for me to simply state that that is a load of unadulterated bullshit that you have been brainwashed to believe by the media, society, culture, and your own mind.  So I have to be more gentle in the service of being effective and kind.  This is pretty much the first task in almost all therapy I do: disabusing people of the Bullshit Doctrine.  There never was anything wrong with you, and you don’t need to be fixed.  You were never broken, and so if we try to fix you, we will just fuck you up some more.  Ever try to fix an apple?  How about a sunset?  Ever try to fix a flower?  Do you often bring your cherry blossoms in for repair?  Didn’t think so.

Bullshit Corollaries: Something is Broken About You

So once we accept the primary assumption that you’re broken and need fixing, the rest follows.  Since you are a machine that needs fixing, then we need to find what part of you is broken.  Usually, it’s your “self-esteem”, a concept which I’ve spoken about already as pernicious, false, unsupported, destructive, and ultimately meaningless.   But there are other, more sophisticated models of what’s supposedly broken about you, including the currently prevalent “evidence-based” model, mainstream “cognitive” therapies (for instance, Beck’s Cognitive Therapy ), which are based on clinical speculation followed by clinical trials that show that they “work”.  These therapies are better than most, and in fact I used to offer such therapy in my practice.  It’s highly logical and has some empirical support.  However it is not nearly as backed by behavioral science as its proponents claim.  Studies examining mechanism of action in Cognitive Therapy , for example, have failed to show that cognitive change is the factor that accounts for clinical improvement, which is a BIG PROBLEM for their theory.  Anyhow, the Bullshit Corollary in this case is, “What is broken is the way you think, and what has to be fixed is your thoughts.”  Bullshit.  You think the way we all think.  Human cognition is fundamentally flawed, but not broken and more importantly, not fixable.

Bullshit Method 1: We Will Convince You 

It’s nice for your friends to try to cheer you up by convincing you that you are worthwhile, or by the same token, that you are thinking wrong and need to think right.  It’s quite another matter for convincing people to be the basis of a therapist’s approach.  Basically the idea is that I will either sweet-talk you into thinking you’re great (instead of shitty, like you feel), or I will brow-beat you into accepting that your views are flawed and need to be changed to my views.  You take these two approaches, “support” and “disputation,” and you have much of the work that is being fobbed off on the public as good psychotherapy.  You may as well talk to a friend, it’s cheaper.

Bullshit Method 2: We Will Figure it All Out Together

A more traditional approach is that we’re going to sit and review ad nauseam your past, and figure out exactly what went “wrong” so we can “fix it” by talking about it a lot.  This is a great money-making proposal for therapists!  You sit for a few hundred sessions while I scratch myself and make small utterances like “hm” and “ah?” and “how did that make you feel?”  The remainder of therapy is probably covered by this, what isn’t Bullshit Method 1 is usually Bullshit Method 2.  Proponents of these methods by the way usually don’t even try to claim “empirical support,” and when they do, it’s the same kind of evidence base as the CBT, support-and-dispute body of literature, which is based less on behavior science and more on post-hoc clinical trials that show, well, it works well enough at making people say that they feel better.

An Alternative to Bullshit Psychology: A Modest Proposal

What I recommend as an alternative to bullshit is psychology that is based on behavior science from the bottom up.  This can be found in behavior analysis, and more specifically and more humanistically in Contextual Behavior Science , the only game in my business that seems worth playing.  What we are offering here is a combination of good scientific basis for what we are doing, and a Humanistic, compassionate stance that vigorously rejects the ideas that 1. We are more mentally healthy than you (we certainly are NOT), or that 2. We have special knowledge to impart to you that is what you are missing (we DON’T).  What I mean by expertise, when I say “I am an expert” is that I know that much of what I know is bullshit.  That is exactly what I mean by being an expert.  First, we are Human beings, perfect as we are, flawed yes, but not machines to be fixed.  My proposal is that by looking together at what our minds tell us, by contrasting that with our actual EXPERIENCE of life, and by contacting what is most important to us — our values — we can peel away from the pernicious agenda to perform an “anxiety-ectomy” or “depression-ectomy,” abandon this stupid and futile project of removing what you don’t like, and get to work on aligning your life with your values.  Get to work on changing behaviors to match what we are most deeply committed to in our lives, what we want to be able to write about in our memoirs.  That is NOT usually “She never was depressed” or “she defeated her anxiety.”  Those never make it into the top 3 bullet points people want in their memoirs.  Psychology needs to be about what we care about most: the people, principles and activities that are most worthwhile to us.  The rest is bullshit.

Do you agree? Have a slightly, or very, different view? I want to hear about it!

Would you like to work on life in a way that assumes you are NOT broken? How would that be for you?

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Joseph Rhinewine, PhD. People collaborate with me to live life fully: with principle, passion and vigor. My expertise is providing and teaching Acceptance and Commitment Therapy (ACT), an evidence-based, experiential and relational behavior therapy. I also apply Acceptance and Commitment processes to coaching those who wish to take their lives to a new level.

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  • Chris Fadness

    Albert Ellis’ Rational Emotive Behavior Therapy is essentially what you are talking about, which I believe is the cornerstone of all CBT approaches. Looking at what our minds tell us as opposed to actual experience. Thats what REBT is all about. Its not necessarily the theory/technique, its how it’s presented. I like how you present it as “you are normal, don’t need to be fixed”.

    • Almost. Al Ellis got it 90% right, but he took the “I am an expert, you are a fucked up person and I’m going to straighten you out approach.” I had 2 sessions with Dr. Ellis and spoke with him a number of other times at conferences. I loved the man, and wrote about him when he died (see my website for the piece, available as a download). However I disagree with him rather sharply as to how to do therapy. For him it was all about disputation. I take from him my foul mouth and my irreverent humor, as well as the general view that we are all fucked up, every one of us. However, he still divided us into people who are “nuts” or “meshugineh” and those who aren’t. And he is a prime example of the disputation method. Still, I imagine that REBT has evolved. Does it look a lot like ACT now? My friend Hank Robb, former student and colleague of Dr. Ellis, has mastered both, and I’ve been meaning to chat with him on this very topic.

      • Chris Fadness

        Yes, thats what I was saying, its how you present it. He presented it as: I’m this, your that, in that cantankerous fashion of his. I take his ideas, mix it with Carl Rogers (amongst a lot of other things), get a tastier dish…Yes, ACT is great, DBT is great. Over all of this rides the active ingredient: the relationship! Yalom! Thank you for all of your posts and vids; great stuff!

        • thank YOU Chris, for your kind comments and for doing wise, compassionate and skillful work with your patients! 🙂

      • HH

        “I take from him my foul mouth and my irreverent humor, as well as the
        general view that we are all fucked up, every one of us” ABSOFUCKINLUTELY!!!

        Some therapists think their job is to “fix” the patient, not help them adjust to their circumstances or work their way through their issues. You can’t “fix” a person with PTSD, for instance. They are already broken. To “cure” that person would involve erasing or altering the memories that caused this. You don’t try to “cure” some patients.. you help them adjust and cope. Adjusting and coping will never make PTSD or physical pain go away. That person will not sit smiling as they “cope”….they’ll still be suffering. We wouldn’t deny medication or therapy to a person with a broken leg just because they’re “coping” with it.

        • Sure — language is all relative so I might say, as I did in my post, we who suffer psychological issues are “not broken,” but it might also sometimes be more useful to allow the thought “I AM broken” and accept that. Either way language is a game (c.f. Wittgenstein). Whatever works! (and discard, we hope, what does not). As a therapist, the presumption “My patient is not broken” seems helpful, but I could see it becoming invalidating if I took it too literally or held it rigidly. Then I’d have to ARGUE with them about whether they’re broken… (I wish I could say I’ve never fallen into that trap… 🙁

          • HH

            Perhaps “broken” is an incorrect term. The person IS forever altered…and I see therapy as a way to validate the person’s condition and help them adjust to their new reality.

          • Yes, for sure — what is learned is NEVER un-learned. Rather, we learn new things. The new things we learn can put the old in a new context — and this can be very, very helpful. But we do not un-learn (except in the movie Eternal Sunshine of the Spotless Mind, in which a surgical procedure removes unwanted memories).

          • Even there I’d qualify — we can learn to do things very differently. But the memories of the old behaviors persist. Under the right circumstances, the old behavior can come right back. Because it was never forgotten or “un-learned”, actually.

          • HH

            Agree with you. Perhaps “broken” is not the correct term….although we agree that it IS “smoke and mirrors”… I think of my chronic pain, for instance, as a “new normal.” My back can’t be changed, and although it won’t go back to the way it was before (and therefore is not “healed” although it was “corrected”), it’s not exactly broken anymore. Am I the only one getting dizzy here? LOL

            I disagree with the therapists who want you to somehow adjust your reality to “accept” what isn’t acceptable, or to “dismiss” the pain and after-effects. That is NOT going to make them go away.

            I had surgery, physical therapy, the whole buffet. After several months of this, I was told I had healed as much as I was going to, and what I had left is what I had left. I still get emotional when I think of that moment, because the bottom dropped out of my world. I had expected to go back to my life and my sports.

            I was a figure skater, a skydiver and a hiker. My body remembers the sensations…stroking fast, faster, cold wind on my face, smell of ice, cut back, toe into the ice, up…up…turning, turning, down, glide out. My body remembers how it feels…and won’t do it again.

            I remember running out the back of the plane, wind in my face – there is no sensation of falling in skydiving – you are suddenly weightless and floating, and only when you look up at the plane getting smaller above you do you realize you are truly falling. For almost a full minute you are literally flying your body. I won’t do that again. Oh, I could still do it…if I could still do it.

            This hurts.

          • Yes. It hurts. I wish they had something better for you.

  • David Ebaugh, LCSW


    Great post. I admit I am excited new research that comes out validating effects of behavior, such as mindfulness, on the brain. I even carry with me an fMRI image of my own brain, a souvenir from a brain study. I love the cool fMRI imaging that verifies what many of us as clinicians already know through direct experience: when we change our relationship to our experience, our experience changes. The cool pictures help to verify that the change is really and truly happening. Often time, in our skeptical western, science-based culture we need to “see” proof before we can embrace new concepts or new ways of thinking. I am a firm believer in the power of behavior over cool pictures, and I am always looking for new ways of motivating my clients to act, and then watch the changes come. My latest go to resource on this is Richard Wiseman’s “As If Principle”. In this book, Wiseman articulates and expands upons William James’ axiom, “If you want a quality, act as if you already have it” citing curent and classics examples from decades of psychological research. A favorite TED talk to demonstrate how behavior initates changes such as increased self-confidence, I’ll refer client to is AMy Gunn’s talk on power posing http://goo.gl/2PfxF

    Great post, Joe. Looking forward to more.

  • Ron F

    An example of the bullshit. I was a therapist in a state outpatient substance abuse program. One day I went into my office . There was a man waiting for me. he held 2 huge manila files on his lap.

    He said he has a serious drinking problem and needs help [something wrong with him]. After giving me his history of his drinking life and the horribly rotten things he has done under the influence, he handed me a file and said that he had several years of therapy from this doctor who is considered an international EXPERT in addiction treatment.

    Then he handed me the second file saying I spent 2 years in this psychologist’s program. He’s considered the most outstanding psychologist in the country…AND I’M STILL DRINKING.

    Almost LIKE A CHALLENGE, he handed me the files and said, “Can you help me?”. I took the 2 files full of what you call bullshit and said, “I’m not the greatest therapist in the world or the country. But I’ve only known you for an hour and I can tell you why you are still drinking’. He looked startled almost scared and said why?

    I said you’ re still drinking because you “somehow” find yourself in front of a glass of booze, grab it and bend your elbow and drink it. If you didn’t bend your elbow you’d never drink it.

    He looked like he wanted to run out of there. He saw I would expect him to change his behavior. He really didn’t want to stop drinking and the files were a justification for continuing this behavior and ease the guilt he had for the things he had done to people near him. He wanted me to build a 3rd file of bullshit for him and he knew I wouldn’t. In my talks with him I gave him this feedback to develop this realization about himself and create a vision of the life he wanted for himself as a motivation to stop drinking.

    I asked him to do his own behavioral functional analysis by keeping a journal of the “somehows” he found himself in front of the glass of booze and develop alternatives.
    He saw that 100% of the time it was getting together with old buddies. All of his needs for socialization were met by relationships with heavy drinking friends who get together in bars. He saw he needed to develop non drinking friends. I said that’s a great idea. He tried, but he lived in a small town and his reputation made it difficult to move in other circles. He had relatives in another city with more social options than meeting in bars. He moved and I moved to another job so I don’t know the outcomes. At least he didn’t get another file of bullshit from me.

    • Ron, thank you so much for this story! It’s not just an example of bullshit — it’s also an example of what Behavior Analysis can help people do. You wonderfully capture that moment… that moment when he has the terrible feeling that… you’re NOT going to give him more bullshit! Just a great clinical tale and testimony of the importance of a solid basis for what therapists do. We don’t know the outcome, but we know that he learned something that is at least potentially valuable and applicable. More important, you helped him have a moment of genuinely seeing the problem experientially. Thanks again for this post.

  • dr

    I suppose I largely agree. Though ill add that ACT/mindfulness/dbt take the bullshit to a whole other level

    • I would like to hear more about what you mean. My initial thoughts are that I agree that mindfulness approaches certainly CAN be used in a bullshit way, and I’ve seen ACT (obviously my favorite paradigm) used in a totally bullshit way, to say nothing of other mindfulness approaches. What’s not bullshit in my book is the research that ACT draws on, especially Relational Frame Theory, and the underlying philosophical approach of Functional Contextualism. How these are best applied clinically is anyone’s guess, but ACT is about as evidence-based and evidence-supported as they come. So while some may write off my entire field, and all scientific research in my field, as bullshit, I really have no idea why one might do so other than just to be negative. If the latter characterizes accurately your view, then I guess I would just respectfully disagree, and express curiosity as to how you reached that conclusion. That said, once again, I do think that ANY research and ANY therapeutic approach can be easily recruited in the service of bullshit, and often is.

      • Mike

        Joe, you sound like a person of a particular faith that says that all other religions are bullshit but that theirs is not. Also like religion everybody THINKS they have evidence.

        People’s emotions, feelings, lives and interactions with others are all very subjective. Science can’t be used to ‘prove’ ANY form of counselling because:

        a) There are SO many factors (the human brain is thought to be the most complex machine in the entire universe, and they are all different! That’s a little hint’.
        b) A subjective field can’t be tested by an objective system (science).

        if you look at the research on counselling you will find that there is conflicting research all the way down the line. Some studies say all therapies are just as effective as each other (Dodo effect), and other studies show that one is better, but another piece of research says it is worse. These are the sorts of results that you would expect when using an objective system (science) on a subjective object (counselling).

        You are obviously now too heavily invested in your chosen paradigm (ACT) to give it up. Not only are you earning money from this, you also presumably have some form of social respect in some areas. So to admit your paradigm is just as bullshit as all the others would be too much for your ego I presume?

        You are also probably suffering from cognitive bias. i.e. you hunt out research that agrees with your stance.

        All people need is to talk to kind and understanding people. Note that empathy, congruence and unconditional positive regard can’t be taught. People are either useful to talk to with one’s problems or they aren’t, and that differs for different people.

        Counselling is a sham profession. One study showed that people totally untrained as counsellors did just as well with real clients that FULLY trained counsellors. This research has been repeated many times and always gives the same results. Sometimes the untrained people are better than the trained professionals with years experience. That also hints that it is probably a sham profession.

        • Ok point for point:

          1. I have no faith in my paradigm but it seems to work and we have some good empirical evidence. If those two sources of information change, so will my paradigm.

          2. I agree that nothing can be proven in science, only falsified (see Popper’s work on philosophy of science), however I reject your claim that a subjective aspect of Human experience cannot be measured objectively. It seems to come from a lack of knowledge of my field. Please set me straight if I am incorrect in assuming you are not trained in the empirical aspects of social science(s).

          3. Yes, I am advertising my paradigm. I am also blogging and impact is my main concern, rather than scholarly thoroughness. To be sure, this topic deserves a much more thorough and balanced discussion. The blog post under discussion here voices a strong view in favor of my chosen paradigm and challenges discussion.

          4. “Counseling is a sham profession”… Not sure I disagree completely, but it does seem you can cherry-pick research with the best of them. There’s also lots and lots of research showing therapy works. However as you point out the “Dodo Hypothesis” suggests different forms of therapy may not be so different.

          ACT has at least as much support as other forms of therapy and I argue it is superior in its philosophical basis. Am I biased? Yes, of course. And so are you.


  • Giles

    The author of ‘Screw Work Let’s Play’ a motivational careers book and the instigator of the scanning cult at scannercentral.co.uk claims in the advertising in his book that he had a counselling and psychotherapy practice for seven years, though he has no qualifications. The misleading way he spins this is to call this time ‘seven years’ of professional development.’ When challenged about this by me on the amazon.co.uk site he claimed that he never intended to go down the ‘theraputic route’ when challenged as to whether he actually had patients. He also told me that my conclusions about his book, which does not even rank as pop-psychology meant that I had ‘read the wrong book.’ The Amazon.co.uk listing for his book contains a lot of fabricated reviews. He even got one of his fake psychotherapist friends, in the business for nearly 20 years, to reply to my post in which he resorted to name-calling and a devaluing tactic by which he called me a bully for daring to criticise a book his friend had written. The basic lack of respect this man and the author have for their readers and the ‘how dare you?’ attitude is sympotmatic of a deeply narcissistic nature. The need to preach, be recognised and have paying followers is motivated by a chronic mental illness. The author is a very deeply mentally ill person driven by a need to acquire supply in the most cynical and exploitative ways possible. He has an advanced diploma from the Coaching Academy which could put him in touch with vulnerable people at some stage. I went through all of that when I knew him personally, not a nice experience.

    • Bullshit is more common than Hydrogen — perhaps a building block of the universe.

      • Giles

        Hello Joe. I thought stupidity was more plentiful than hydrogen, but I’d be happy to debate the point.

  • Thorvalt Clinton

    First of all, Joe, fuck you

    I have been through so many therapists, and none of them even so much as came within a fucking whale sharks ass to pointing out that I have anxiety and that that’s an important obstacle to being able to appreciate my body..

    And I have spent thousands and thousands of dollars (and thousands of dollars) on therapy to NOT be told anything helpful, whatsoever.

    I don’t necessarily think that this has anything to do with the specific or particular type of therapy that they were schooled or practiced in.

    I just think these people were fucking morons who did not deserve the career they had and whom turn the prospect of education into a total abomination.

    So in summation, Fuck you, you know if this applies to you.

    • Thorvalt,

      I wrote a long post, point-for-point responding to your post and somehow it got lost, sadly.

      Maybe it’s best this way as I can be briefer.

      When someone starts and ends a message with “fuck you,” it’s hard to know how to respond. However being a native New York City kid, I can handle the rough language and anyhow my post didn’t pull any punches and was pretty rough in its own tone.

      Your post overall confused me. It seems that you agree with some of my points (most psychotherapy is a waste of time and money), but disagree that the “school of thought” of psychotherapy is important. I would say that school-of-thought is important, and so is being a smart, wise, skillful, compassionate and caring person. Each is necessary but not sufficient to be a good therapist on the whole.

      The other point was that perhaps I might seem as if I don’t believe in diagnosis? That I took as implied from your first point (the one after “fuck you” that has to do with therapists failing to diagnose your anxiety). Actually I’m a firm believer in accurate diagnosis, so I hope I didn’t create the impression that diagnosis is not important. This is a subtle point, but maybe best captured by stating that most of us are diagnosable with something.

      Finally, with regard to your conclusion–“Fuck you, you know if this applies to you”–I will quote the immortal Frank Zappa: ‘That’s the nicest thing anyone has said to me all day!’

      May you be well,


    • grevyturty

      Yeah your sample size of one is certainly enough to condemn a whole profession. No wonder you failed…maybe it’s fuck you, not Joe?

      • Thorvalt

        If you’re happy to fuck disadvantaged people for whom there was an obvious remedy instead of the therapists who presided over them totally overlooking it as if they were not even paying attention almost as if they were just grooming their clients for a lifelong existence as a cash cow, sure. Or, fuck you and go scalp your eyelids off. Goodnight!

      • Thorvalt Clinton

        It’s amazing you have the gall to call out someone and condescendingly embarrass them when they have undergone significant suffering.

        Guess what: Society does not exist to furnish you with an upper middle class existence and a stupid pretty wife who can not think for herself.

        Do you think I would hesitate to ruin your reputation if we met in real life? Do you think I would not confront you on your stupid ideas and self justification? Do you think I would not reduce you to a quivering little bitch about to wet his pants because his vanity has been impaled?

        By all means, go flirt with an electrical socket

        • grevyturty

          Your weak minded threats are funny. Did you even finish high school? Do you know what evidence based practice even is?

  • These comments and the above blog post just supports my belief in common sense and critical thinking skills that most people lack these days. Thanks everyone for the entertaining read.

    • Well, as I mentioned in my response to Thorvalt, I acknowledge I wrote a pretty provocative and feisty blog post. As such, I can expect some push-back, and not always polite pushback. It’s all good.

  • John

    I’m not going to call bullshit or tell anyone to fuck off. I am going to say that ACT has not worked for me so far. I’m sad and upset about it, AND I’m sticking with it because nothing else has worked for me. Help!

    • Dang. Sorry to hear it John. ACT is not the only game in town; there are other contextual and humanistic therapies, for instance FAP (Functional Analytic Psychotherapy). I am also a firm believer that biology is not irrelevant, and sometimes medications and other somatic approaches can be useful. It’s also sometimes useful to examine what you mean when you say it is “not working”. Hope that helps some.

  • Danielle

    Absolutely. I appreciate your honesty. Sadly many of your colleagues are far too narcissistic to do likewise. Psychotherapy can be very powerful, indeed! Unfortunately, in my particular experience, it was powerfully damaging. I will spare you the details. However, I when I read your article it resonated deeply.
    A very bad experience with therapy makes it difficult to trust anyone especially another therapist. I have toughed it out with serious depression on my own because I am literally afraid to seek professional help. I have a MA in Clinical Psychology and once had a considerable amount of confidence in the profession.
    Obviously, one person does not represent the entire field, but the circumstances were so traumatic and the extent of the betrayal was so painful that I am still dealing with the aftermath (years later). Entering treatment was by far the worst decision I ever made. I would be much better off today if I had not done so.
    All that said, I’m doing my level best to navigate this stuff on my own. I know I need to let go of the past and try to move beyond it. I’m trying to allow the experience to be useful to me somehow. Living in the moment is the only way I can survive. I know that. You are right, life is difficult. Sometimes extremely difficult and there are no easy answers or quick fixes.
    Than you for your post.

    • Thanks for posting this Danielle. I’m very sorry to hear of your experience and I wish that it were less common. While research shows that psychotherapy, on average, tends to be helpful, that research is based on large numbers of people and ignores instances of psychological damage caused by therapists who are ostensibly trying to help. Others may benefit from your courage to share your story, and use caution in choosing a therapist.

  • M, Dave

    I am no one big, or educated, just a simple person who stumbled upon this article researching for myself why psychology is bullshit. Not to better myself by giving myself more self-esteem and believing I don’t need help, but because I went through something traumatic recently, and a friend who is dear to me tried using her “psychology” studies on me. I called her out on all the bullshit that it contained, and shes been mad at me ever since ( its been two days..). I read some of the comments below as well, and just as “Ron F” has pointed out, with the files, most people need the obvious approach, you are doing it because you want to. I also believe that drugs, or medication isn’t always the best answer. Maybe we just need an exercise routine? A healthy eating habit that does not include processed foods, we as humans were never meant for that. I myself believe that people all over rely more than they are meant to. “We are all screwed up”. Maybe we aren’t, maybe its society putting all these pressures on people that screw us up. This is why the “good kid who gets everything” hurts more when he’s hurt, as the fat kid, hardly hurts, because hes used to it. Experience. I feel that the world needs less reliance and more independence. I believe you when you say, we need to skip the bullshit, and go straight to what we value, and set our focuses on what we want, its almost selfish in a comical, but a truthful way. This is also why I feel that the world has flawed our design of love. We fall inlove, marry, have kids, divorce, repeat. Was that necessary? If we respected others as much as respected ourselves, we wouldn’t rush into complicated situations as such, cause sacrifices, marry for love, when we should be marrying for common interests, similar values, etc. I fear the world will never recognize these issues, and continue to delve into the subconscious idea that we all need to own, consume, and that will always lead to unhappiness. No one will accept things for just what is. So many ideas and topics on my head, so many issues that need to be dealt with and so much more bullshit stories to help people “cope” and hide the fact at hand, when all they really need is a slap, and a “stop doing it then” speech. Find your values, and truly do what you want, to a degree, of course.

    My rambling is done, Good post. Glad I read it.

    • Thanks for your comments Dave. I enjoyed reading your post. It seems to me you are asking the “right” questions and dealing with them in an honest way. I would think that this approach will pay off for you more and more as life goes on. Regarding the “Bullshit-hood” of psychology, of course, the other side of that is, the only reason I’m here to say these things, the only reason I have the job I have, the only reason I can make these very critiques of psychology, is through the generosity of psychologists who have given me so much in terms of examples — positive and negative — of how to respond to the Human dilemma. So I am biting the hand that feeds me! But, my hope in doing so is that I might be able to save people some time in separating the “Bullshit” psychology from the really helpful stuff, the best stuff I have found in 20 years bumping around in this field. Is the “Bullshit” I am pointing our REALLY total bullshit? Of course not. My post oversimplifies, it is a challenge and a provocation. I owe an enormous debt to psychodynamic psychology and cognitive-behavioral psychology, which here I bash savagely. Why? Because I want to save people the time that it took me to get to what I think is the best my field has to offer. AND because I am selling my services. So, I want to be genuine and show people that genuineness can work, it can be worth the risk (i.e. admitting that I am selling here). BUT I also want to make my case very clearly, which unfortunately involves distorting the picture in order to even get as much attention to this matter as I have. I am very grateful also to you and others who have responded to this post. It means that I am not wasting my time. I am grateful to those who have pointed out the Bullshit in my calling Bullshit. It means that I can be “wrong” and flawed, even at the very same time as I am trying to be helpful, and indeed, for some people, being helpful (they tell me). This means we’re all Human, and if we want to–if we REALLY want to–we can drop the Bullshit and start living and loving. Now my rambling is done too. 🙂 Namaste.

      • M, Dave

        I like that. I don’t mean to say you are wrong in any way. Helping is helping, one way or another, that is awesome. I just felt the need after reading something I feel very right myself, to, for some reason, also add. I think your way is a good way. Thank you again.

        As for grevyturty. We as humans were never meant to digest foods made with excess amounts of chemicals, or genetic modified foods. We do, of course however consume it, but it takes a toll on our bodies just like most anything else. Liver failures, heart issues, organ malfunctions of various kinds. Not saying “organic” is the way to go, but consuming food that naturally occurs ( carrots, meats, beans, etc etc ) may help reduce a lot of our own stress, anxiety, laziness, etc etc.

    • grevyturty

      ” habit that does not include processed foods, we as humans were never meant for that.” Never “meant” for that? You’re not very logical are you? Meant by whom? Were we “Meant” to fly in airplanes??

  • grevyturty

    Interested to know your thoughts on Albert Ellis’ theories and his approach. They seem to be undervalued as the Beck model of CBT is prevalent now. Any thoughts?

    • Well, I’m no expert in contemporary Rational Emotive Behavior Therapy (REBT), but as I mentioned in a previous post, I have been a long-time admirer of both Beck and Ellis, have met both gentlemen, and have spoken at length with Dr. Ellis. I think both of them did great work, but it was current and ground-breaking in the 1960s. We’ve gone SO much further in our understanding of psychotherapy and what is helpful, and what isn’t. Sadly CBT is often practiced much as it was 50 years ago, whether from a Beckian or Ellisian (??) perspective. Both are hierarchical and mechanistic, so my article classes them as “Bullshit,” of the “You are flawed and we will fix you” variety. I do understand that’s not the attitude many CBT practitioners take. But it is embedded in the model in many cases. There is a Constructivist form of CBT that is similar in philosophical background to Contextual Psychology (the basis of ACT, which I practice). However for the most part, Albert Ellis’ approach is emblematic of the “you are fucked-up” approach. He said this in so many words. He was unapologetic about his stance and I loved him for it. Again I understand (speaking to the REBT practitioners reading this) that current REBT does not necessarily contain Ellis’ brash and condescending sort of attitude. Further, Ellis was a huge fan of Contextual Psychology in his later years, as evidenced by his high praise for the Relational Frame Theory book edited by Steve Hayes (see rear cover of that book, Ellis’ praise for book). After all that verbiage I will say that Ellis was interested in the most “elegant” and parsimonious approaches, and came to view all psychopathology as variations on a single cognitive distortion, that of “Demandingness,” the demand that life be different from how it is. In this he was more philosophically penetrating than Beck, who tends toward a rather academic model that can be less parsimonious and incisive in my opinion. Again, not really my area of expertise. I see both as being very flawed approaches, as my post overstates.

  • Ah, gentlemen — I am going to refrain from posting some of the further back-and-forth that I am getting in my mailbox. I’m willing to take a lot of verbal abuse on my page, but I don’t want those posting to abuse one another. In fact I may remove some that I have approved, lest I be accused of silencing one party and not another.

  • Ted

    I am not fully understanding your theory. I would like to believe I am not “broken”, but my dog (pictured) telling me to kill, Kill, KILLLLL makes me think otherwise. How does this apply to those with severe mental illness (acute anxiety, depression, schizophrenia) or those with suffering from the psychological effects (i.e. PTSD) from physical or emotional abuse and trauma? Is there a genetic component to mental illness and what is your position on psychopharmaceuticals?

    • Excellent questions Ted and thank you. Let me explain further with regard to your particular situation:

      1. I spent a decade or so in schizophrenia research. It’s a real disease (or set of diseases) that involve neurodevelopmental compromises to the brain. Put my name into Google Scholar if you wish to see my work in that area.

      2. Medications are very often helpful for psychotic symptoms though they tend not to have the desired effect on longterm outcome.

      3. The helpfulness of psychotherapy for individuals suffering with psychotic symptoms is grossly underestimated by many mental health practitioners. See for instance the study on Acceptance and Commitment Therapy for Psychosis (also available on Google Scholar I think).

      4. Does considering yourself to be “broken” help? Then by all means think of yourself that way. Does it help when your therapist regards you as broken or flawed? Then sure, let them do that. But might it be better to view your condition as a medical condition in need of appropriate treatment — and you as a whole, complete individual and a representative of the neurodiversity of the Human race? We have no use for psychosis in our society, but in tribal societies it can be highly valued. I’m not saying that means it’s not a disease in our context because it is. Don’t confuse me with Szasz, Breggin, RD Laing or any of the anti-psychiatry people. I am not anti-psychiatry. If anything I’m a critic of psychology, my own profession, even at the same time as I am an advocate for it.

      5. I hope your condition improves — and even if it doesn’t, I hope you choose to live your values no matter how loudly the dog shouts at you.

      • Ted

        Thank you for further explaining your conceptual continuity.
        -Ted (The Man Who Was Talkin’ to the Dog)

        • You are most welcome! I hope your dog hasn’t been too modified, and if she is, I send her a most ornate doily. #ZappaLives

  • Mick Berry

    Hi Joseph, I’m not sure how far we’re gonna get writing to each other. This is because it’s such an inefficient method. Also, people usually take umbrage at being proved to be wrong, and will defend themselves when confronting sound arguments, as they wrap their ego up in their ideas. I will go ahead anyway. I do think there is a lot of bullshit psychology out there, but Rational Emotive Behavioral Therapy, in its principals of recognizing our self-defeating thoughts, and growing in our capacity for self-helping thoughts, is extremely sound. It doesn’t state there is something wrong with someone, and something right with the therapist who can help the client. What it does hold to is that there are certain things which can be taught, and those same things which can be learned. And some people versed in what’s helpful can teach those very same ideas to those who can benefit from learning them. I do agree, that many therapists need as much, if not more instruction on how to stop disturbing themselves. (Albert Ellis entitled a chapter “Your most difficult client: yourself”). Our thoughts create our feelings; our demanding thoughts create our disturbances; our accepting thoughts create our mental health. This is all that REBT claims. It’s not hard to understand, and not time consuming to implement. Often people attempt to reinvent the wheel. And what they do is hold up the spreading of truth by making the situation cluttered. Freud certainly made the world a much worse place with his bullshit ideas. All human mental disturbance (anxiety, depression, anger–yes, anger, a very self-defeating emotion and experience.) comes from demands which we place on ourselves, other people or the world. I do see Cognitive Therapy obfuscating this truth. However it is at least modestly helpful. Rational Emotive Behavioral Therapy is more efficient, by getting to the core of self-defeating thinking: demands. We create our emotional state of mind; we can learn to create our emotional health. And there are many that do this naturally who require no instruction whatsoever. For those that are disturbed, and seek help, it’s out there. I would say that I can offer help to anyone who wants to learn from me. I offer help to myself daily from the ideas I learned in REBT, taught to me by Emmett Velten, Michael Edelstein, and Albert Ellis. We don’t need to discover how to solve mental disturbance. We do need to spread the word. I am more than willing, I’m eager to engage anyone in a conversation about this. As I said before, writing is not nearly as efficient as a discussion. P.S. After Robin Williams died, I saw so many people talking about depression as being the cause. That doesn’t quite nail it. You can be depressed and still think that your situation is temporary. What cause suicide is hopelessness. That’s what does everyone in that takes his/her own life. I do wish that there was a wider discussion of how to achieve mental health from people who can make a realistic contribution. Many people, in fact I would say most I come across on the internet, don’t even know that it’s not our situations that create our emotions, but we as individuals and our self-defeating or self-helping mental habits, that create our emotions. Likewise, we can learn to take care of our own personal emotional health. I am open to a discussion at anytime with anyone. Like I said, writing is quite inefficient. Unfortunately, that’s what’s usually done these days. Conversation is much more interactive and better for instruction.

    • Joe Rhinewine

      Agreed about the shortcomings of this medium for communications. And, you said a lot, but I’ll try to be brief and at the same time try to do justice in my response.

      I was Albert Ellis’ client. I believe he did think that people were “fucked up” and he said so. I take him at his word. I do think much of the REBT method is sound but there are so many pitfalls that many people — including Ellis himself — carry out the therapy in a way that can do more harm than good, at least in some cases. We can do better. We SHOULD do better, preferential “should”! 😉 Ellis and REBT were cutting-edge psychology in, oh, 1965. He was a one-note symphony and a giant, and we stand on the shoulders of giants. But REBT doesn’t make it in my book anymore. My post was overstated and bombastic, not a great piece of intellectual work, but more of a political statement and a declaration of my principles. I do think that there are many people doing REBT and CT compassionately and humbly. And a lot of people really screwing the pooch following the manualized versions of these techniques. I have seen it from every angle: 1. As a patient; 2. As a trainee; 3. As a therapist; 4. As a supervisor. Cognitive change has not explained therapeutic outcome in massive NIMH-funded studies run by the very advocates of Cognitive Therapy, who have as much as admitted (nobly) that they cannot prove their theory. REBT has a more elegant approach but I beg to differ that it does not posit that there are “Rational” and “Irrational” thoughts and that “Irrational” thoughts are to be “Vigorously disputed.” I can’t quite get how that characterization of REBT can be inaccurate when it’s exactly what Ellis said for decades and decades. It might not be “bullshit” but it’s not 2015 psychology. It is at best, 1980s-level work.

      Perhaps someday we can have this conversation in a civilized way, in person, with beverages of choice. 🙂 Meantime, nice to meet you, if in this rather impersonal, 21st-century, disembodied way.

      • Mick Berry

        (Written after the post below) One last thought Joseph (after reading another post below) I really don’t think Al himself would say “You are fucked up”, but that “Your self-defeating thinking is fucked up”. There’s a big difference. And I often heard Al say “Watch your language.” Being specific is always beneficial.

        • Joe Rhinewine

          Here’s where the medium becomes burdensome, as we have only so much time to type here, but let me try to clarify… 1. Al did characterize my parents as “meshuggah” which means “crazy” in Yiddish, and he uses the term”crazy” to describe patients often in his humorous songs. Do you really think he didn’t think people were crazy? Maybe what you mean is that he acknowledged that we are ALL crazy — which is why I respect him more than some of the other proponents of CT who seem to think that “irrational” thoughts are something that only certain people have a lot of, while others are quite rational. 2. “Rational” vs. “Irrational” doesn’t hold up well. A rational thought (or even a ‘reasonable’ thought) could be very unhelpful. For example, if I strike out one inning of baseball, then the next inning I have a thought “I struck out last inning.” That’s not irrational. That’s not unreasonable. It’s factual! But it doesn’t help me connect with the ball this inning, not at all. We need to change our RELATIONSHIP to thoughts, which is the 3rd-wave behavior therapy credo, which is why I characterize REBT as 1980s at best. 3rd wave focuses not on changing the content of thought, but on changing the relationship one has to the thoughts. Actually Ellis was very impressed by this approach and wrote high praise on the back of Steven Hayes’ et al’s book Relational Frame Theory, exact quote: “A remarkably brilliant book that integrates some of the main theories of radical behaviorism with cognitive behavioral theories and practices of psychotherapy. This book gives more plausible explanations of why people behave the way that they do, and particularly why they are frequently dysfunctional, than any other I can think of.” (Albert Ellis, Albert Ellis Institute, New York) Ellis himself recognized that 3rd wave was terrifically important and was humble enough to acknowledge that this work is an advance over his own. 3. We have to consider what ordinary therapists will do with a manualized treatment. My blog post was addressed to the general public. Ellis pulled NO PUNCHES WHATSOEVER when he criticized psychoanalysts, and I have taken a page from his book as a fellow New Yorker and as his former patient and admirer. I saw how my CBT/REBT-type approaches were terrible for some people. I get clients who found both psychoanalytic and 2nd-wave CBT treatments unhelpful to them. This post was for them. I want to validate how invalidating the 2nd-wave CBT approaches can be. When Aaron Beck does CT, he does it well with compassion and humility. Ellis? Well, he was a character, but his approach worked for me. Not for everyone. I want to do much better if I can. When I converted my practice from CBT to ACT I went from helping maybe 60% of clients to 90%. Instead of calling people “crazy” or “Personality Disordered” or “Resistant” or “too irrational,” and writing them off as “therapy failures,” I deem the therapy itself to have been inadequate to help them. When our work is inadequate we need to do better, we SHOULD [preferential] do better. This is what Marsha Linehan also discovered with DBT, another 3rd-wave therapy. I believe Ellis would have vociferously argued with my post, and then admitted, based on his own experiences, that I had a point. 😉 He hated psychoanalysis and would never have given an inch on that argument (I know because I had it with him). However I think he understood RFT and saw the potential for it going beyond REBT. People I have learned from such as Hank Robb (of Portland, former Ellis student) have successfully combined REBT with ACT. I think ACT is a crucial revision of the CBT’s. So crucial, that I feel comfortable, for the sake of my patients, pulling no punches in excoriating out-of-date CBTs, at least in this context. Thanks to you too for a civil and interesting debate!

          • Mick Berry

            I agree. Here is where the medium doesn’t offer efficient discourse. But we do what we can. (Another way it doesn’t offer efficient discourse is in the elimination of the warmth of someone’s voice, the maintenance of respect and lack of contempt.) Anyway, I’ll respond here as I read your most recent post. 1) I’m certain Al would say that everyone has tendencies towards irrationality. It’s endemic to being human. Some have better mental habits than others. But everyone can be more rational, and those that have better mental habits, towards rational thoughts, are capable of their skill becoming diminished, while those with less rational thinking habits can learn to become more rational. 2) In response to certain CBT therapists thinking only some people have irrational thoughts, they’re wrong. Everyone has irrational thoughts. I’ve yet to encounter a human being that didn’t. Regarding your statement about hitting the baseball…”I struck out last inning” is rational. The irrationality would be saying “I should not have struck out last inning.” Acknowledging striking out, without demanding that it not have happened, while also not demanding that “I must not strike out this time.” does help us achieve our goals. Acknowledging the striking out can then allow us to address the practical problem of “Why did I strike out?” The answer could be anything from “I swung too soon” to “I didn’t swing fast enough”, etc. Rational thoughts don’t solve practical problems in themselves. They allow us to then address the practical problem without burdening ourselves with the additional complication of an emotional burden. I would go so far as to say that acknowledging the striking out is crucial to getting on with the next step to not strike out again. REBT would say to maintain not demanding ourselves to get a hit…retain the desire to get a hit without turning it into a demand to get a hit. I am interested in learning what exactly you mean by our relationship to our thoughts. I have found my use of REBT to take care of every emotional problem I could possibly encounter. However, I know that people can be stubborn as all hell, and that helping the client is the end goal. If for some reason a client is not helped, it is an abhorent use of the position as therapist to write them off as a bad client. Al was continually reworking his own ideas, best exemplified in the name of his therapy changing over the years. When I first started using it, it was called Rational Emotive Therapy. I’m sure you know that before that it was called Rational Therapy. Now it’s, of course, Rational Emotive Behavioral Therapy. My hunch is that many of the ideas contained in your method are things I’ve thought of on my own, and I would still classify them as REBT. But, I have found some corrections to Al’s ideas, from things as simple as him saying “Life is spelled H-A-S-S-L-E.” I would say that life is spelled “Not necessarily cooperating with our personal desires.” How we deal with that determines whether we think of it as a hassle or not. Our interpretation of life is determined by us. The bottom line is that reality is the saving grace in getting us out of “stinking thinking”. However, there can be more efficiency to REBT and I am open to learning it. Thanks again for your gentlemanly discourse. I’m enjoying it. Most people I know think that childhood trauma causes mental disturbance. Freud did more to foul up mental health than anyone else I know. What a charlatan! Jung, probably as bad, but not as famous so the harm is less. Anyway. Have a good day.

          • Mick, I thought you might like to know that, prompted by our dialogue I went and re-read portions of “The New Guide to Rational Living.” I think the theory is much more solid than I was remembering. I am planning on removing the “Bullshit” post from my blog (once you see this comment). REBT has a lot more going on for it than I am giving it credit for, and while my BS post was very popular, I think in the last analysis it’s unfair. I’m going to write a post that addresses the mis-application of solid psychological theories, and how this misapplication frequently renders psychotherapy ineffective.

          • Mick Berry

            I really appreciate the open interchange Joseph. I think it’s vital (though unfortunately uncommon) for people to discuss ideas aiming for truth, rather than ego boosts. This can be a very tricky thing. I do think Al Ellis’ approach can be improved upon, but what I usually see happen is that therapists misunderstand him, and faultily apply REBT. I know you’re outrageously busy, but it’d be great to talk on the phone whenever we can manage. However, I know that this might not be possible. Let’s stay in touch however possible. You seem like an extremely conscientious therapist, who values the client’s benefit as the foremost importance. My experience is simply as an individual who has learned to apply realistic thinking to his own life, which has eradicated my own problems with depression. But whenever I engage people (usually other lay-persons) with the idea that it is our thoughts that disturb us, and not our circumstances, I invariably am met with hostile opposition. This in itself is not insurmountable, but what ensues is usually a granite wall of obstinacy. This, in turn, eliminates any further discussion. I would imagine you encounter many difficult therapists. The field of psychology is rampant with irrational individuals. Albert Ellis himself once told a therapist friend of mine “Whatever gave you the quaint idea that therapists at my institute would be rationally following my ideas?”

          • Haha that’s great! He was similarly hilarious about the folks who ejected him from the Albert Ellis Institute. I would actually love to talk on the phone. my email is [email protected] — let’s move the convo to email if that works for you.

  • Alasdair Horn

    I’m about to start training as a psychotherapist, and am trying to decide what modality to train in. It seems this is an important decision, as the first thing I learn will most likely be what I refer back to when newer modalities get confusing. I was planning to learn Transactional Analysis, Inegrative Psychotherapy, and CBT. I have confidence in CBT – it seems logical and it helped me get over my OCD, which I suffered badly from for 4 years. However, your article above seems to discount Transactional Analysis and CBT? I could be wrong, I am still new to this field. My background is in Electrical Engineering, I am a sicentist at heart, but one who wants to help people with their mental health problems. So naturally evidence-based stuff appeals to me. I see so many people online who think that all of therapy/psychology is a scam because their therapist didn’t help them. I want the opposite of that result. I want people to have confidence in the methods I learn, so I need to have confidence in them too. I have the funds to train in TA, Integrative, and CBT, but obviously don’t want to learn these if they aren’t valid. Everyone seems to have different opinions on what works. I just want to go straight to whats sound, but lost among all these different methods at the moment. I like Buddhism and Mindfulness too. And Carl Jung’s Typology – it has helped me a lot with my career choice. What should I train in?? Thanks in advance 🙂

    • First, let me say that I am in the process of writing a revised version of this post that is more fair, and less hyperbolic. My post was a challenge to therapists and it has generated some great discussion. However, it was bombastic and hyperbolic, and there’s more to CBT and REBT, as well as psychoanalytic approaches, than I am admitting to in the essay. However, I obviously believe that Contextual Psychology (ACT, FAP and related approaches) are the best game out there. I don’t know much about Transactional Analysis but it seems interesting, if dated. Basically my beef with my field is that people don’t seem to keep up with the literature. I think you may be putting too much faith in me to tell you what to train in! 🙂 However, my bias is, train in CONTEMPORARY CBT, which means DBT, ACT, FAP, etc… rather than what was cutting edge in 1960-1980, Beck’s CT or Ellis’ REBT. I like Jung too. I just think it’s not very practical for most purposes to do psychotherapy from a Jungian perspective, but then again I’ve not trained as an analyst, Jungian or otherwise. I do hear a lot of my clients complaining about psychoanalytic approaches that they have tried in the past and not gotten much from. But I have a biased sample in that I attract people who want something different. DO read the lit on the controversies surrounding CBT and why we have a “3rd Wave” in behavior therapy (i.e. “evidence based” therapies, CBT’s). Good luck and feel free to write again.

      • Alasdair Horn

        Thanks for the advice! I will follow up with research on the “3rd Wave” as you say. It is very humble and professional for you to suggest not relying solely on yourself to choose which to study. I have a couple of other things to mention, that I have read about. Firstly, I’ve read that some successes in therapy can be contributed to the Placebo Effect – people think that they should be getting better beacuse they are in therapy, so they do. To what extent, in your opinion, does this play a part? Secondly, I’ve also read that the most important thing is the relationship between the therapist and the client, and the modality is of little importance. Perhaps this is more relevant to Pyschotherapy rather than CBT? Also, I’ve read some therapists who’ve said that a lot of their patients just want a compassionate ear to listen to them, and the actual theories/methodoligies they use
        often don’t even come into play. Does this line up with your experience at all? Again, perhaps more of a psych phenomenon than CBT. I’ve ordered the following books to help me research further:

        Thanks Joseph!

        • Absolutely. You are totally on the right track with Jerome Frank. Psychotherapy’s effects are mostly due to “common factors” of psychotherapy which Frank outlines, and subsequent literature demonstrated that the single most important predictor of outcome in psychotherapy is the therapeutic relationship, the interpersonal aspects of the therapist-client relationship. That said, what I was addressing really pertains to progress in psychotherapy and how we can be more, or less, effective. Common-factors therapy was mastered by the 1950s. I believe it was Hans Eysenck if I am not mistaken who threw down the gauntlet with a study that suggested that psychotherapy is not effective. Subsequent studies demonstrated unequivocally that psychotherapies ARE effective, but we are not sure why. So then the question became, as Jerome Frank put it, “What intervention, for what individual, in what situation will be most effective?” We’re still working on this. Meanwhile there have been advances in behavior therapy that most of my field ignored for years and only now are they catching on (DBT, ACT, FAP, etc). My post came from my frustration on hearing repeatedly from my clients that their prior therapists were only somewhat helpful, and most of those people were practicing a “traditional” (perhaps watered-down) CBT or a psychodynamic (psychoanalytically-oriented) therapy that helped a bit but didn’t go the distance for the client. To me this is a real problem, as I think we have advanced beyond these basic approaches. FAP does what contemporary psychodynamic approaches do, and more systematically and logically. ACT does what traditional CBT does and better, and consistent with newer research, and can explain its effects. See the work on Cognitive Therapy in which the very proponents of CT (to their credit), determined in a large, NIMH funded study of CT that while it is effective, the effects are NOT due to cognitive change. This is an enormous problem for their model. I think I mentioned that in the original essay but it can’t be emphasized enough. ACT studies have shown that reducing Experiential Avoidance DOES mediate therapeutic outcome (see wikipedia for mediation vs. moderation in statistics of social sciences). Anyhow have fun and enjoy this field! I’m not as bitter as I sounded in my post. I think it’s a great field but I wanted to be heard, and well, being shrill is a great way to generate a lot of responses. 🙂

  • Yasin

    Quite an interesting article.I have seen tons of people going through therapy and psychoanalysis, I myself included, and the result was hmmmm not that much significant, as they claim it to be.yet they still tend to involve themselves with those sessions.why? Well, I think those sessions are analogous to story-telling gatherings, in which you get the chance to identify with the hero of the story.with a profound difference though, YOU are the hero of this story this time, and that keeps you involved, engrossed and hooked (I need to be careful with this one).
    I personally truly love to scrutinize human behavior and condition, SCIENTIFICALLY, however what most therapists offer is more like pieces of advice.WARNING: my knowledge of psychology is merely shallow, though I have been to therapy myself alot.

  • Jason

    Interestingly, you seem to have missed the fundamental conflict pervading your “essay.” In simple terms: 1) you bash the EST movement when it serves you to do so, 2) you embrace the EST movement when it advances your argument. Yes, EST’s are complete nonsense (see Shedler, 2015), but your thinly veiled attempt to use Stephen Hayes’ ideas as evidence of your own brilliance is simply bullshit (you know that word, right?). For everyone reading this, Hayes co-founded Acceptance and Commitment Therapy (ACT), and it is considered an empirically supported treatment (EST). This Joseph Rhinewine guy is attempting to pull the wool over your eyes by claiming he hates ESTs, yet he advertises ACT (an EST) as his approach to therapy. Just search his name at PsychologyToday.com. You cannot have your cake and eat it too, Joseph (that would be bullshit). Read Wampold, Wachtel, Shedler, and/or Westen (or anyone from the Society for Psychotherapy Research) and I assure you that you will be a real psychologist soon! If not, you’re little more than a technician, and probably should have gone into social work. Take good care.

    • How odd! I thought I have been clear through my public communications that I am not a founder or developer of ACT. Apparently you are simply trolling and have not read my other posts nor seen my videos.
      Oh well!


  • Andrew Schubert

    “Balony watch” (Scott Miller) has been out there a long time. Funny how psychotherapy is still infected with the medical model instead of strength based practices. However, I see this more with psychologists than I do with LCSW’s and other master’s trained professionals. I do not venture to say why, except many Ph.d programs are still thick with Freud even today, and the deconstruction of the person. And testing. Which has it’s place, but does not bring change. To Alasdair, I would tell you you won’t get to pick a “modality”.. and if you did, you would be limiting your clientele by your lack of eclectic and client driven approaches. If it is a “modality” it is probably bull.. Read up on Scott Miller’s stuff and William Glasser’s Control Theory, believe that people have their own strengths, and learn to ask questions and make observations that encouraged an individual to find their own answer. Read up on Rodgers client who sat by his mailbox for therapy and paid him nontheless… Modality counts for about 9% of change that occurs in therapy..the clients own strengths, 40-50%, and time/life itself accounts for about 15.. so… and resist labels and diagnosis..you will have to use them but they are invalid baloney.

    • Hey thanks Andrew, this is one of my favorite comments so far on my somewhat bombastic blog entry of a few years back. Interesting that you see this problem more with psychologists; I wonder if MSW programs are getting more hip to strength-based approaches and were never as in-love with ideas. I do love Glasser’s Control Theory but it seems like almost nobody teaches it anymore per se — I ran across it randomly in my pre-grad-school readings. I do think that the level of validity of diagnoses does vary with the particular diagnosis; for example sometimes a diagnosis of OCD can be useful and certainly a diagnosis of Tourette’s Syndrome is useful. But most people who see a therapist are not in need of a diagnosis or label, nor are they in need of a new set of Emperor’s Clothes placebo behavioral procedure to “feel better.” Or a meal of baloney as you put it. They need to make use of their strengths and maximize spontaneous remission–which I would say works via the client’s values system (basically a revival and refinement of Victor Frankel’s Logotherapy, with a behavior analysis framework). All the best to you.

      • Andrew Schubert

        Joseph, I read Frankl every year. The psychologist “thing” that I may perceive may be as a result of knowing more therapists than psychologists as well as fewer graduating psychologists these days. Most psychologists I know are older than myself and came from schools with psychoanalytic backgrounds. I think SW programs are more progressive at first appearance, but it is just a snapshot opinion, really. I think there can be some value in some diagnostics as you say. Tourette’s is really a neurological dx with a standard behavior that doesn’t deviate much, though degree is not a variable in the diagnosis. (Of course, most of our DSM dx’s are nuerological, we just aren’t smart enough to come up with tests so they can move from “psychological/behavioral” to “medical”) I’ve always said it isn’t the diagnosis that is important. What PROBLEMS the individual may define themselves as having is the focus of my work..I remember writing a goal on the old evil treatment plan for a teen.. 1.A. “Jerry will be able to smoke as much pot as he wants.” Of course, people thought I was nuts. But Jerry concluded he could not achieve that goal and have other things he wanted….so the goal then became “Jerry will convince his parents that he can be trusted to go out with his friends on weekends.” Then, “Jerry will define 3 traits of a trustworthy teenager and display these traits daily.” HE wrote those goals, none were related to his DX of depression, and he succeeded. HE decided to lay off pot, he and his parents both made changes, and no medication needed any more. Of course, eventually state Medicaid ate those REAL kinds of treatment plans, so no more of those unless it is a private practice plan. . My goal has always been how to help the individual recognize strengths and how to apply these to THIER perception of the problem..or to accept themselves as they are if they decide this is important to them. I have to laugh aloud when I see someone looking at the APA manual on approved treatments for diagnostic categories. Anyway, thanks for the compliment. We think alike in many ways. Best wishes.

        • Indeed, great minds — well, anyhow SOME minds — think alike! Hilarious (and truthful) tx plan story. One of my mentors (who was actually very psychoanalytic but not in such a traditional way) said of the heinous tx plan form at a CMHC, “you can put down ‘client will grow a second head’ and it’ll be fine.” The funny thing is, I know people who have their heads screwed on right who are psychoanalysts who do great work, and I know people who are ostensibly Humanistic/Existential and all that “good” stuff who don’t seem to be doing too much of anything with most of their clients. Like you said, it’s not really about modality. Anyhow, great chatting with you. If nothing else, my hyperbolic essay got a desired stirring and reaction out of people and has led to some good chats and new connections (as well as some challenges, and even borderline-hate mail. But no death threats so far. 😉 Be well.

  • James

    The more I read concerning criticisms of empirically-supported treatments (ESTs), the more I recognize the same red herring over and over again. A theoretical orientation gives us a model for conceptualizing a disorder and for selecting targets and different types of interventions to then affect change. However, the error individuals make when considering the use of ESTs is to state that the orientation or treatment must be adhered to as stringently as in the RCTs used to develop or validate the treatment. I myself use CBT for the treatment of gambling disorder, and I recognize that inaccurate beliefs concerning the odds of winning contribute to the disorder. I have tracked change in those beliefs and observed marked reductions in gambling behavior as a result (although, I would have to attempt a reversal to be sure, but this makes little since when changing in belief!). Still, this approach and such a conceptualization is not at odds with developing a healthy therapeutic alliance or respecting the client’s autonomy. I don’t believe this approach necessarily labels the client as dysfunctional or disordered. Also, disputation doesn’t have to occur with the therapist in the expert role, but instead the therapist and the client can engage in collaborative empiricism. If I have a client using their own words and their own insights to come to the realization that their beliefs or behaviors are at odds with THEIR OWN reality, this does not say that they are, as you say, f’d up and need to be fixed.

    In summary, most of the critics that I read about concerning ESTs, especially those criticizing CBT, act as if therapists who adhere to these approaches walk into session, guns blazing, calling names, and telling clients how they need fixin. No competent therapist would behave this way simply because the model or treatment manual they use failed to reiterate the basics of reflective listening, rapport development, and therapeutic process. Sure, Ellis did not emphasize the role of therapeutic alliance or rapport, in fact I heard he was a real jerk, but that doesn’t mean his approach cannot be used in a client-centered fashion. Thus, it really just depends on the individual therapist, and no theoretical orientation can make a poor therapist, a rigid therapist, or a therapist without basic knowledge of therapeutic process (how to successfully apply interventions) into a good therapist. It’s not the treatment approach that’s important, it’s how you use the treatment approach you have! Yet we still cling to these things as if they were chiseled on stone tablets. Perhaps that’s just human nature…

    • James — thank you for this thoughtful and well-articulated comment. I agree with your points. A couple of comments that do not contradict your observations, but might temper them, in line with your concluding words on Human nature: 1. “…No competent therapist would…” this is part of the point; we need models that foster competence and do not easily lend themselves to incompetence, as I believe some ESTs do. 2. Psychology must progress and improve; the underlying theoretical models in traditional CBTs are out-dated in my view, leading us to out-dated approaches, even when client-centered. The newer models (contextual) lead to more sophisticated approaches being more accessible and frequently used by even newer therapists when taught properly to them. 3. “…at odds with THEIR OWN reality…” I like this very much, and it’s pretty close with my own approach. I’m not thinking it’s how CBTs / ESTs are usually taught. I hope you teach and mentor a lot of students! 🙂 4. My essay was deliberately a bit heavy-handed and provocative, and has generated a lot of dialogue, with the cost of coming across as perhaps more of a firebrand than I really am most of the time. I do see value in many ESTs other than ACT etc. However if one is not loud, one is seldom heard. This is by far the most frequently read and commented-on essay I have ever written — so, the internet selects for shrillness. For that, perhaps I should apologize but maintain that it was my chosen method of being heard. Thank you again for your fine comments.

  • Art Marr

    Presented here is a new definition of mindfulness that describes mindfulness using a neurall informed theory of learning. It is based on several published articles that derive mindfulness from a radical behaviorism. The analysis owes nothing to ACT, but everything to Skinnerian principles.

    Links below to relevant sources

    Simply defined, mindfulness represents continuous non-judgmental awareness. But the converse of non-judgment, namely making judgments, may entail negative outcomes (perseverative judgments as represented by rumination, distraction, or worry) or positive ones (non-perseverative judgments on what to have for dinner or what route to take on the way home). Perseverative cognition is uniquely correlated with stress, anxiety, and depression, but non-perseverative thought (as well as thinking of nothing at all) is correlated with relaxation, positive affect, and feelings of happiness. Thus it may be concluded that the definition of mindfulness over-prescribes the type of cognitive operations that need to be curtailed in order to attain positive emotional outcomes. It follows that the definition of mindfulness must be attenuated to represent the avoidance of perseverative judgments alone. By no means does this invalidate mindfulness, rather it merely details the type of judgments we should be mindful about, and allows one to be easily mindful all of the time rather than from time to time that is the practical result of parsing all judgment.

    This definition of meditation complements the ‘perseverative cognition hypothesis’. As advanced by the psychologists G. Brosschot and JF Thayer, “The perseverative cognition hypothesis holds that stressful events cannot affect people’s health, unless they think repetitively or continuously (that is, ‘perseverate cognitively’) about these stressful events. Stressful events themselves are often too short, as are the physiological responses to them. Therefore the physiological responses during these stressors are unlikely to cause bodily harm. More importantly, many stressful events are merely worried about, or feared in the future, while they often do not happen or do not have the feared consequences. Nevertheless, the body reacts with prolonged physiological responses to continuous thoughts (perseverative cognition) about these stressors. Therefore it is the perseverative cognition, and not the stressors that can eventually lead to disease. In scientific terms, it is said that perseverative cognition is a mediator of the detrimental effects of stress on one’s health.”


    A longer explanation of perseverative cognition is here.


    • interesting, thanks!

      • Art Marr

        since you are so into BS psychology, and rightfully so, a link below to my other little book which is proudly BS!


        • Ha, funny! I like anything that makes me LOL as I did from: “Csikszentmihalyi/pronounceable.” Looking forward to reading the rest!

          Are you aware of Glenn Ellenbogen, e.g. “Oral Sadism and the Vegetarian Personality,” the Journal of Polymorphous Perversity, etc?

          • Art Marr

            YUP. And its a hoot! I would however make this modest recommendation for all newly minted psychologists that they take a job at the post office rather than academia. They get tenure, they don’t have to publish (thank God!), and if they are wrong, at least they don’t have to quit their day job. As a lay-person myself but not unfortunately a postman, this is wonderful insurance for when I am invariably wrong!

          • Dodged that bullet! That’s why I went into private practice. I’d say government work is probably the best gig around, but not sure I’d thrive as a postman. I like to eat, so firefighter maybe…

  • Cookie Lipschitz

    One area in which I find all therapeutic “modalities” lacking is any acknowledgement that the society in which we live is utterly fucked up, wasteful of human potential, and that many social problems are medicalized for profit. I’ve come to this after many years of unemployment due to being involved in things in which society at large has little interest (ecological restoration and “field” vs. “bench” biology), growing up with a nonverbal learning disorder and a rough childhood, and after many years of “therapy”. RD Laing may have been full of shit in regards to many aspects of the “therapeutic process”, but he seems to have been the last person to take social conditions seriously when it comes to the misery suffered by individual humans. I’d certainly be interested to hear how social conditions figure into your methods.

    • Yes. Emphatically. I like RD Laing very much (“Knots” is my single favorite book in mental health) though yes he too has his limits. Foucault also has his own share of BS but makes important points. When I do therapy, increasingly I try to use the following analytical “lenses” in interpreting content implicitly as well as explicitly, depending upon context–in no particular order, and here treated very briefly: 1. Economic (the Bernie Sanders candidacy for instance having brought to the forefront in the USA the effects of economic inequality); 2. Feminist / Gender / Sexuality dynamics; 3. Ethnic / Cultural / Linguistic / Immigration dynamics — for example, I am only the 3rd generation here in the USA as all 4 of my grandparents are from E. Europe, and the trauma of that immigration is traceable to my own behavior and has impact on my children, the 4th generation; 4. Evolutionary, which can subsume all the others as a level of analysis as it is a very powerful explanatory framework though often not useful, but we have, it appears, “burst through our breeches” in terms of the speed of technological progress versus biological evolution. So, yes. But then again, no — RD Laing is hardly the last to have paid attention to social conditions. There are a great number of Race/Class/Gender theorists in my field. There is however a dearth of really good research in these areas unfortunately due in part to the enormous disparity of funding, which favors biological research over everything else, and “cognitive-behavioral” approaches over more “social” approaches. Further, there is a tendency for the R/C/G folks to get so political that they stray from science since they often decide what they’d like the results to look like, and they don’t want biology to have any influence at all, or to have a certain influence, and not another. Sigh. American Psychological Association generates a lot of attention for R/C/G research, which I seems unequivocally positive. Generally I think we are making progress, which may not show through my cynical posture.

      • Cookie Lipschitz

        Thank you for your considered response. My mother is a survivor of the Shoah, and most of her family was murdered, and the multigenerational trauma created by this has been and additional burden. It’s unfortunate that there doesn’t seem to be anybody with your perspective here in New Mexico, poorest state in the US and one with a very backward thinking psychiatric/therapeutic community. Increasingly, I see political action to be a “therapeutic” endeavor as much as a practical one, and in that vein tried to form an organization called the New Mexico Union of the Unemployed to help people to organize and demand more out of our elected officials, who would rather spend billions on refurbishing our nuclear arsenal located on the Air Force base just outside of town rather than spending that money on the intractable unemployment faced by hundreds of thousands of the citizens of this benighted state. In addition, I thought that people would be interested in a collective business incubator approach to pooling human resources and potential rather than waiting for a handout. Unfortunately, I found the unemployed themselves to be their own worst enemies, having, to paraphrase Paulo Freire fully absorbed the oppressor consciousness. Americans seem to have a hard time moving from apathy to active dissent. So, I think we need something completely novel, some sort of an active process that involves less “therapy” and more action. I’d appreciate your thoughts and those of the readers of your blog.

        I also wonder at what point the for profit “therapy:” industry, and never mind the modality, become s a hinderance to serious social change by concentrating too much on the individual and not on their interrelationships within a social context. Frankly, I no longer trust anything in the US that is done with profit as a central motivation.

        • Well, I’d say that depends. I’m not exactly in a neutral position to judge, but we all gotta eat, and I think I have as much right to pay the bills as anyone else by my trade. As I do so, I do hope to empower those who need to be heard, rather than oil the cogs of the machine. That said, I do get the critique that therapy can often simply function as the latter. And as you probably already deduced, my family is also Jewish and while my branch of the family left Europe in the earlier 1900’s (for Ireland, N and S America), presumably there were other branches of the family that were not so lucky and no longer exist — thus the uniqueness of our family name. Everything must be understood in its context. Non-contextual psychology runs the greatest risk of simply oiling the cogs of an oppressive society.

        • HH

          I am so sorry for what your mother went through. Dear God. Sometimes, yeah, you do remember that what you went through isn’t as bad as what someone else endured.

  • Cookie Lipschitz

    In an unrelated matter, I’m wondering why you chose to use the term “mindfulness” when this is already well-associated with a school of pseudo-therapeutic Buddhism?

    • hm. Well, first let me say I like your Johnnie Cash f-you photo, a classic. I think your comment reveals both familiarity and lack of familiarity with the subject. “A school” is not really what’s happening as the association with Buddhism and other Eastern traditions is much looser and broader and there are many, many such “schools” tangentially as well as directly involved in the phenomenon of mindfulness in the West. I would not call mindfulness much more “pseudo-therapeutic” than most of what passes as therapeutic actually. The Mindfulness-Based Stress Reduction program at the University of Massachusetts Medical Center has been gathering data for decades demonstrating at least modest therapeutic usefulness of mindfulness techniques derived from Theravadan Buddhist practices as introduced by Jon Kabat-Zinn who designed the curriculum. That said, meta-analyses using Cochrane Database’s stringent criteria have shown the cumulative data to still be tentative and reflect “potential” rather than rock-solid therapy. On the other hand, the term “mindfulness” is not well-defined and could refer to any technique or related therapeutic approach that employs attentional control, a broader construct within neuropsychology. When one uses a term one needs to define it. My own definition uses 4 of the 6 ACT processes, those understood to be “mindfulness-oriented,” specifically Present-Moment Awareness, Cognitive Defusion, Cultivating Willingness to Experience, and Contact with the Observer Self (or Self-As-Context). All of these are “googleable” or see my videos on the topics. ALL of that said, another, much simpler answer is, as a psychologist starting out in a competitive market (Portland, OR), I needed a brand, and ‘Mindfulness’ was a rising concept in our culture around 2008, so I grabbed it. How much did it help me? Probably bubkes. Most people even here don’t know from mindfulness, but it does attract perhaps 10% of my clientele who have a specific interest in mindfulness, which is nice. I have a certain role as therapist to the fringes of the Buddhist community, and practicing nominally as a Zen meditator, that is nice.

  • HH

    Thank you. I’m depressed due to chronic pain, and am sick of my doctor trying to push group therapy or worse, that cognitive behavior bullshit at me. Yes, I am depressed. I would rather just deal with it by not dealing with it than sit with a group of people I don’t know and have no interest in getting to know, or “learning new ways to think” which I define as spoon-feeding people don’t worry-be happy smarmy crap. I’m a no-nonsense, get out of the way so I can get my work done person. I had an absolute, utter loathing for team-building exercises and “icebreakers” back when I was still able to work.

    I can’t “distract” myself with a hobby or activity I enjoy since I am no longer capable of doing those things. Nothing will ever make not being able to do those things okay. I don’t want to chat about it with people I don’t even know about it or take pills that will turn me into a grinning zombie.

    Sometimes depression is about grieving. Why is that not okay to some doctors and most of the people we know? No, I’m not nice to be around right now, and that’s what everyone who knows me seems to want – fix her so we don’t have to deal with this and be made uncomfortable. I edited this to add that I live alone, and people don’t have to come over if they don’t want to be around me. If you do, accept that I will not smile, laugh, crack jokes or listen eagerly as you tell me how great your life is. I am not the person I used to be, and never will be again. I’m in pain. All. The. Time.

    • Thank you HH. This is very valuable, what you have said. I wish doctors would all read and understand it.

      I have at times thought of pulling this post down as it has made some people angry. But I have left it up because of responses like yours.

      I wish you peace, within and beyond your grief, and in finding continuing meaning in your life. And I hope you find more helpful and insightful caregivers.

      • HH

        Peace to you, too, sir. Please DO NOT take this article and discussion down. It’s too valuable. One person CAN make a difference – and that’s what you’ve already done for the patients who have responded to you here.

        I’ve been this way for five years, since I injured my spine. I waited three weeks before I saw a doctor, thinking I’d pulled something and just had to wait it out. That alone should be proof that “don’t think about your pain and it will go away” doesn’t work for me…..

        Keep fighting the good fight. You’re in a position to make change in the field, and you are the voice for folks like me.

    • DeShawn Allen Hunter

      >or “learning new ways to think” which I define as spoon-feeding people don’t worry-be happy smarmy crap. I’m a no-nonsense, get out of the way so I can get my work done person. I had an absolute, utter loathing for team-building exercises and “icebreakers” back when I was still able to work.

      As an Aspie, god fucking yes.

      >Sometimes depression is about grieving. Why is that not okay to some doctors and most of the people we know? No, I’m not nice to be around right now, and that’s what everyone who knows me seems to want – fix her so we don’t have to deal with this and be made uncomfortable.

      This should be bookmarked for future reference.

      >I can’t “distract” myself with a hobby or activity I enjoy since I am no longer capable of doing those things. Nothing will ever make not being able to do those things okay. I don’t want to chat about it with people I don’t even know about it or take pills that will turn me into a grinning zombie.

      It is commonly assumed that all cases of depression are of the neurochemical, “all in your head” variety when it is simply not possible to be happy in certain circumstances. People just think about the anhedonia wherein people can do things they used to enjoy but have no effect; it doesn’t occur to them that anhedonia forcibly induced by external reality would make any sane human depressed. If I lost my legs, antidepressants can’t fix the consequences of that.

      • HH

        I LOVE your reply!!! Hello from another Aspie, by the way!!! I was an honor student, but was constantly harassed by teachers who shoved me into group projects and assigned me to “peer tutoring” (forcing me to do THEIR job) with the sole purpose of “helping you make new friends.” Teachers and shrinks – introverts and Aspies DO know how to make friends, so please, for the love of God, quit trying to “fix” us and start accepting us. Nobody tries to change folks with other disabilities – just the aspies.

        That’s another reason why group therapy and cognitive behavior crap doesn’t work for everyone. Abstract thinkers, high-functioning autistics (who are highly intelligent and live in the mainstream world) and introverts are poor fits for group therapy and CBT. We can see through the charade – (adapt your “thinking” to eliminate negative thoughts and the sun will come out and kittens and rainbows will appear).

        CBT is smoke and mirrors, just like “The Secret” and Creative Visualization. Some people deal in facts, not smoke and mirrors. I haven’t met an introvert or an Aspie yet who likes going to the doctor in the first place. We tried everything we could possibly do for ourselves before we finally admitted we were sick or injured beyond our ability to treat at home.

        • I love this! I’ll just chime in very briefly — MOST of what I do as a psychologist is “smoke and mirrors” in SOME ways. We have a THIN evidence base, but we have some. It’s a question of what will help, for whom, as you both obviously get. That said, if it comes across as insincere, it’s not going to be helpful. I try to be helpful if I can, but someone called mine “The Impossible Profession” and I often agree. 😉 Thanks for conversing on my page, it’s an honor.

          • HH

            Please, remember that there ARE people out there who are in real pain and not just in search of drugs. Yoga? We wish we could twist our bodies into those positions. Meditation? if that worked, we would never have needed to visit a doc in the first place. I was an athlete and hiker before this. Don’t worry, be happy :Cognitive Behavior Therapy will not fix damaged nerves

          • Hm.. it’s been long enough since I last posted to this thread that I’m not sure exactly what verbiage you are responding to in this comment—or whether you are addressing me or another participant in the discussion.

            Nonetheless, to clarify my views on the issues you raise.

            1. I am a firm believer in multimodal treatment for pain—which includes medications. The recent “crackdown” on prescription pain medication has been very damaging to some of my pain patients. Similarly, over-prescription of pain medications has also been ruinous to some in the past. The authorities are vascillating so frequently and vigorously pertaining to opioid medications in particular that one could get whiplash. This is unhealthy: some people need chronic opioid treatment and benefit from it. Others need to rely upon it less.

            2. Yoga is much broader than Hatha yoga positions. Unfortunately in the West it tends to be taught as if all yoga is is twisting into various interesting positions. I am not an authority or anything more than a casual student of yoga, but I’m in consultation with those who are. Yoga can involve breathing exercises and other very gentle approaches, as well as “mental” and other internal exercises.

            3. Meditation, likewise, is not the only way to practice the many skills that are grouped loosely as “Mindfulness”. The data for mindfulness meditation alone—not in context of functional contextual psychotherapy such as ACT, is actually not as strong as many advocates of Mindfulness believe. My message is not, “just meditate and all will be well.” As you point out, if that were true, people would not present at my office nearly as frequently. The data in support of effectiveness of Acceptance and Commitment Therapy for chronic pain is on the other hand very strong.

            4. Re “don’t worry, be happy,” I could not agree more. ACT differs significantly from traditional CBTs in that it does not attempt to change the content of thought or emotion, but to change our relationship to these in er experiences to one that works much better. It involves a change in the CONTEXT in which the pain or psychological distress function, which reduces their impact on one’s life, leaving more room for our most cherished values to be lived in some form.

            5. Re “…damaged nerves.” The intention of ACT and related therapies is certainly not to repair damaged nerves. In fact, pain reduction per se is not a major goal, and evidence suggests that not much pain reduction is achieved typically in such treatment. What is often achieved however is an increase in functioning level, reported life satisfaction, and meaning and purpose of life. It’s fantastic when various treatments—from chiropractic and PT to surgery and medications—can remove or relieve much of the pain. However, pain reduction is not what I am trying to do. Increase of life quality, meaning and purpose is. And I do not think the two goals are antagonistic. This I encourage my patients to seek out and follow through with various treatments for pain and other medically based conditions, including major depression. In no way do I question the legitimacy of the physical damage patients’ tissues have sustained, some of which may never heal. However no physical damage, short of extremely severe brain damage, can prevent psychotherapy from potentially helping the domains which I mention, of functionality and meaning/purpose.


        • DeShawn Allen Hunter

          > Hello from another Aspie, by the way!!!

          “I’m a no-nonsense, get out of the way so I can get my work done person. I had an absolute, utter loathing for team-building exercises and “icebreakers” back when I was still able to work.” It resonated with me. It all makes sense now. A low-IQ neurotypical would never say that.

          I’m guessing this means, given the psychological similarity and tendency to objective, analytical non-optimism, that I would be well and truly fucked if I ever got chronic pain. I respond very poorly to pain and horrible, permanent situations. With pain, I care nothing for the feelings of others. I wanna scream/moan/etc. in their presence.

          The damnable thing is that I’m still healthy, able-bodied, etc. in a low-unemployment-rate area and still don’t have a job. I loved being a stocker. The one time I did get hired in the past seven months, to a great busing position, I fucked it up the next day by promising to show up later Sunday and then oversleeping because I’d been up thanks to the caffeine I drank the previous shift. I got all of fifty dollars from that, and I have a bunch of student loans. The worst part is not money but the fact that I’m still living with my parents–I really don’t want to, I liked my dorm–and being unemployed makes the situation with them horrible given that I was outed as an atheist to them, have a long record of traffic tickets and have crashed two cars (the second time, it was fleeing the scene of an accident because I was stupid and hurried enough to not take my driver’s license with me, and the high adrenaline and lack of knowledge meant I wasn’t thinking clearly), and have a long record of not showing up for classes and flunking some of them thanks to the fact that I no longer have a car and have ADD (meaning I’m not a responsible normie like my mother who handles getting to class with public transportation well).

          What Color Is Your Parachute? author Richard Bolles cites a 4% overall success rate for people who apply for jobs the standard fill-out-applications-online route, and that’s for the overall population, not autists. Both Bolles and Temple Grandin found that people get jobs by going in through the backdoor–talking to and being interviewed by the people who are looking for skills to fill their needs–and not going through HR, who filter applications by eliminating those with red flags and are looking for reasons NOT to hire you.

          >I was an honor student, but was constantly harassed by teachers who shoved me into group projects and assigned me to “peer tutoring” (forcing me to do THEIR job)

          In a college class, my professors would vociferously object to having one person in a group project do all the work–they would have you come talk to them, so the other group members will be graded appropriately for their lack of effort and your grade doesn’t suffer because of them. The fact that teachers mandated this speaks volumes about the nature of public schools.

          >with the sole purpose of “helping you make new friends.”

          The damnable thing about school–particularly when there isn’t IQ-selection via GT programs, advanced-placement classes, etc.–is that your moral worth is judged by ability to sit still, ability to conform (see also: the Pledge), ability to socialize with stupid people, and ability to catch balls and have good motor coordination. Not intelligence and job skills (see also: http://redpanels.com/7/).

          None of the jobs I have had required sitting still like that, they required hauling ass. Likewise, school dress codes are just extra control and are not necessary to prepare you for a job–although it would be damn fucking nice if they TOLD you that rules are “so you get and job and aren’t a parasite,” instead of it just being social conservatism. I didn’t wear a school uniform, I wore a t-shirt and baggy jeans and wished I had a pair of trips like the goth kids, and I had no problems following dress codes at work and wearing ties to job interviews–the hard part is tying the knot, so I just leave my ties in the knotted position. A job, unlike school, is a voluntary contract wherein either party can leave. If you don’t want to wear slacks for 8 hours, you can opt not to take that job, no truancy laws involved. And most of all, you are paid for it.

          >Teachers and shrinks – introverts and Aspies DO know how to make friends, so please, for the love of God, quit trying to “fix” us and start accepting us.

          I have a lot more friends in college than I had at high school (quote from the school nurse: “Are you stressed? Well don’t be!” It was even more annoying to hear in person) and a lot more friends than I had at “smile and do what the dumb neurotypical teachers want” elementary school (Mrs. Focarile really liked getting me in trouble). Golly gee willikers, I wonder why that is.

    • shagspur

      I have a cold and I feel depressed and lonely. Working on my garden always seems to help. My garden has plants, stones, water and fish. When i get absorbed in my garden, i turn into a stone, or a plant, or water, or a fish, and then I feel ok. There is nothing any other human can do to help me when I’m down, because apparently being human is the problem.
      Incidentally, i’m an aspie, but I prefer to call myself an Erg.

  • Christine Brown

    How come I got banned from posting?

    • You didn’t as far as I know! 🙂 You’d practically have to give me a death-threat for me to ban you (or anyone). I have very, very critical comments up on the feed if you read below. Could be a computer glitch if you got a notice you were banned. Maybe some weird spam detector gone awry?

  • Thanks for your kind words! I’m a huge fan of The Onion myself (best source of news commentary these days). As I’ve stated below I do think my original post overstates my case, but I did want to do so. Psychotherapy works, but yes, most of it is simply support and other “common factors,” and some of the “techniques” simply do not work, and can be counterproductive. Forensic is a great field — and brave! I do love doing assessment, but I only do psychodiagnostics for treatment planning. Usually “what’s going on, bipolar, PD, substance, psychosis — or WHAT??” That’s always quite interesting and I feel like I’m actually accomplishing something discrete. I DO feel like I’m accomplishing things in therapy but it’s often murkier.

    • shagspur

      From personal experience, I must share that from a personal perspective, supported by research by Tana Dineen (psychologist) and Elizabeth Cates (attorney) that forensic psychology is a horror show of forced choice tests, credulous “experts,” and half-baked theories. Forensic psychology corrupts the law, just as school psychologists corrupt education. Do I sound hostile? Walk in my shoes and see how you would feel. Forensic pysch is NOT a great field. it is a nightmare.

    • HH

      I prefer to get my news from The Onion as opposed to Fox Network…..

  • Beth

    Thank you, Dr. Rhinewine. I really enjoyed reading your post. I have been trying for a while now to find a good psychologist and have asked psychologist to not use CBT or EMDR (Ugh…). I suffered mental, physical, and sexual abuse for my life up until adulthood and have been astounded at some of the things I have heard from psychologists. My first psychologist would interrupt me when I would describe what happened in childhood and had told that it “is not important” and that I needed to think in the present. My latest psychologist told me that it would really help with the coping process if I could try to remember fond memories of my family. She had said this right after I described in detail the violence my family exhibits and how my father is a pedophile.

    When I first started seeing a psychologist, I had bad PTSD episodes, but at least had some ambition. Right now, I am at the point where I have developed full on depression and no longer see a point to anything. I am no longer certain how to cope and have yet to find a good psychologist. I have seen 4 at this point. Being told what to think will not help me because it feels as if they would have liked a patient with a cleaner history who can just sweep everything under the rug. Why would someone think that long-term abuse can be resolved by short-term therapy designed to mold their patients into robots?

    • sigh… why indeed? I’m sorry to hear of your experience.

      It would seem that there is a Human tendency to take an idea too far and overgeneralize it, no matter what it is–and therapists are not exempt from this Human tendency. Many CBT therapists would object (have objected!) to my original post, claiming “but I DO respect my clients and I DON’T think they are broken and I DO honor their histories rather than try to ‘reprogram’ them..” etc. And I believe them. However…

      As you have discovered, the paradigm(s) of mainstream CBT covertly and overtly instruct(s) clinicians in many ways to “shut down” and dismiss discussion of trauma, in favor of “cognitive restructuring.”

      I wish I could say with confidence that “All you need to do is find an ACT therapist and you’ll be alright” but that’s not really true; it’s not so simple. I DO think it’s worth a shot though, to make inquiries as to whether there is someone who is very well versed in the Contextual Psychology methods that I advocate — ACT (Acceptance and Commitment Therapy), FAP (Functional Analytic Therapy) and perhaps DBT (Dialectical Behavior Therapy) though I am somewhat skeptical of DBT in some contexts, more than the other two.

      I wish it were a simple matter and that there were a way around the painful process of finding a therapist who 1. is a deeply empathetic person; 2. has a strong, CURRENT scientific basis to their work; 3. has excellent training and a firm commitment to continuing education, taking her/his/their profession seriously; 4. feels interpersonally like a good “fit” for you. But in my experience, that’s what people need, and the more long-standing the problems have been, the more so that is the case.

      I do hope you interview more therapists, much as that probably sounds about as tempting as eating roadkill right now. PsychologyToday.com has a good search engine as far as finding people local to you that have a given treatment orientation. I recommend a brief interview by phone — 10 to 15 minutes. I wouldn’t see a therapist who does not supply such an initial interview for free (brief, by phone at least). If you interview 6 or 7 such people, you can make an appointment with 2 or 3 who seem the best for you. In a smaller geographical area, that might not be possible; in which case smaller numbers might have to do.

      Ask questions freely in such a discussion–it is a JOB INTERVIEW, and YOU ARE THE EMPLOYER. We depend upon our clients for our salary. We cannot earn money without our clients. YOU are our bosses — not the other way around. That doesn’t mean you get to tell us everything about how we must work of course; the work should be a collaboration; it must be in order to be effective. But you are the decider as to whether the therapist gets the job. The therapist of course can also pass on the job — and that’s OK. When I pass on a client, it’s always a good thing for the client as well as me. It means either that the client’s problems are outside my scope of expertise, or that I doubt I have the level of experience and skill to work with that particular person and that another colleague might do better than I would.

      Hope that helps. May you be relieved of suffering; may you be at ease; may you find joy in life.

    • HH

      I bet you get the “you need to forgive and won’t get better until you do” bullshit too. i’m so sorry. “Chicken Soup for the Soul” does NOT heal damage like yours. I hate the way the Me Too folks are told they should just forgive and forget.

  • Marshall Stoner

    I’ve suffered with treatment resistant depression all my life. My problem with CBT is that the “theory” is often presented as a panacea when it is not. The claims that all emotions arise from conscious thoughts or beliefs (which can be “corrected”) is something that sets me off in particular. It just appears that whoever came up with this idea has never experienced true depression.

    It is just blatantly obvious to me that I can feel severely depressed without having any kind of mental narrative to try and justify the mood I am in. Often the first symptom I notice is a loss of interest in activities and a generalized feeling of weight or heaviness all over my body. There is usually no particular event that precipitates this feeling.

    Whenever I encounter “true believers” who claim that their depression has been “cured” through CBT, my natural response is to feel irked rather than happy for them. I feel irked because these people, once indoctrinated, will push the idea that this kind of therapy will work for anyone with “depression”. Notwithstanding there is no scientific evidence that “depression” is a single ailment. It is a wide array of “symptoms” with no singular known cause. Thus it is foolish to believe there can be a singular treatment.

    Don’t get me wrong. I’m not saying that the “thought correcting” theory of CBT is completely useless, or that it could never help me in any circumstances. I do find it helpful in some circumstances. The thing that is unhelpful is when it is over-generalized and presented as a panacea. As a person with a degree science and mathematics, I have a natural skepticism. When a practitioner pushes a theory that is grossly simplified or simply not true, I tend to lose all trust. It simply shuts down my ability to believe anything they say.

    I often feel like some people who find success with CBT and claim it “cured” them off their depression are indoctrinated in a kind of religious belief. It’s similar to how people who believe in an afterlife comfort themselves by telling themselves they will see their lost loved ones again at some point. This belief helps them cope, but this is not evidence that an afterlife actually exists. I feel like these people who are made to believe that they can control their emotional response to any situation (even something chemically/hormonally induced) are benefiting in the same way. It’s a conundrum for people like me who are naturally skeptical.

    Anyways, I appreciated your article. I just wanted to add my own 2C.

    • Joe Rhinewine

      Thank you Marshall. It would be hard for me to agree with your post more thoroughly or more emphatically. I particularly appreciated this: “When a practitioner pushes a theory that is grossly simplified or simply not true, I tend to lose all trust. It simply shuts down my ability to believe anything they say.” That loss of trust is precisely what is dogging us (psychologists) as a field. We must begin to be circumspect, or risk losing more and more fine thinkers such as yourself. Unfortunately I don’t see many signs of that. Unfortunately what I see is a profit-driven rush to bigger and bigger claims. So goes the history of a field in its infancy. It will tend to behave in a manner that’s, well, infantile.

      • Marshall Stoner

        I really appreciate your response. I don’t have as big a problem with the methodology itself as with how it’s sold. It just seems with psychology they did the same thing they did with antidepressant medications. Doctors still tell patients that SSRI’s “correct a chemical imbalance” as if there hasn’t been any new research since the late 80s (or whenever SSRIs were discovered). I think treating patience as if they are all stupid and can’t handle the real truth has lead to backlash. When people learn that therapists are dumbing things down and not telling the whole truth it leads to backlash. In the case of antidepressants it fueled the anti-psychiatry movement which is unfortunately persuading people that medication never works when in reality I’m sure a lot of people’s lives have been saved by taking antidepressants and other medications.

        • Joe Rhinewine

          Yes. For real. [Here I shall begin to rant…] The thing is, the clinicians are often deluded regarding the efficacy of their interventions, so they aren’t necessarily thinking that their patients can’t handle “the truth.” In my experience many prescribers are breathtakingly naive about the research process that leads to medications being designated as “safe and effective.” Even those who are highly knowledgable are subject to a great degree of anecdotal and unscientific thinking. Then on the other side, as you said, there is a neo-anti-psychiatry movement that can be equally naive and half-educated. I have colleagues that seriously believe that “anti-depressants have no efficacy.” This based on a couple of meta-analyses and their own inferences and prejudices. Well gosh, who knows. Maybe SSRI’s are completely inefficacious; after all, no studies have used “active placebos” that cause side effects, so really, none of the studies are actually fully double-blinded, controlled trials as they claim to be. But some of my colleagues act as if NO MEDICATION could possibly be useful for psychological problems — as if there were no nervous system, no biochemistry, no pharmacology, and no extant knowledge of any of these. Some of these same people are happy to smoke a joint and enjoy the benefits of THC and related compounds. What a load of bollocks that “no medications are efficacious, it’s all just chicanery.” I think there is a ton of chicanery in Big Pharma, and perhaps especially in the realm of psychiatry — I should know as I’ve worked in psychiatry laboratories. As my father has said at times, “nobody has a monopoly on stupidity.” Careful scientific thinking is much rarer than I would like, and much rarer than it needs to be in my field, in order for us to earn the degree of public respect that we want. [End rant — enough from me for tonight and have a good one!]

          • HH

            Docs can get bogged down by their own mindsets and over-emphasis on methodology. I’ve written here of my hatred of CBT- the “forgiveness” mantra is becoming equally pernicious by therapists. Victims of the most horrible crimes, like rape, are being counselled to “forgive” their offender, and everything will magically right itself. The media regularly trots out parents of murdered children, etc., as “proof” that forgiveness works. Look at what happened to these people! they crow. They managed to do it. There is no reason, no reason at all that the victim can’t do it, too.

            If the person can’t or won’t forgive, the therapist turns mean. They accuse the victim of wallowing, fishing for attention…you name it. What do churches teach about someone who won’t forgive? You are a bad person.

            No doc would insist that a single drug works for all diseases. I’m appalled that it’s being peddled to people and pressured to make them feel something they can’t, or expect them to be responsible for their tormentor’s crime.

  • DonL

    All of this sounds like a lot New Age bullshit. It sounds like a off-spring of EST or these other Scientology sub-groups. It sounds like a crock to me.

    • Joe Rhinewine

      You don’t say much, but what you say does not strike me as having much merit. Perhaps there’s more to your view? Why I disagree thus far with what you posted: 1. Third Wave behavior therapies such as ACT have little in common with EST as far as how they were derived (EST was someone’s “brain child” and involved little or no prior academic research program), and 2. they have essentially nothing in common with EST as far as how it is/was conducted (EST was coercive; Third Wave behavior therapies adhere to current standards of ethics). Please say a few more words to explain what you mean. I don’t want to close my mind to dissenting opinions, and I wonder if you have some more to say that could enrich this conversation rather than just nay-say whatever has already been said. As you can see, there is quite a bit of interchange here. Simply to call names such as “New Age” (personally I prefer the term ‘newage,’ to rhyme with ‘sewage’!) does not, in my book, constitute a serious criticism. However, again, as a self-appointed bullshit-ologist, if you have more substantive criticism than to compare science with Scientology or therapy with EST, then please state your case.

    • Joe Rhinewine

      Hi DonL,

      I want to take your comments as seriously, but you make it difficult for me. You don’t say much, but what you say is hostile. If I put aside the hostility (after all, my original post is somewhat hostile) and look at what you say on its own merits, there’s a better chance of that. However, what you say does not strike me as having much merit on the face of it. Perhaps there’s more to your view? Few words sometimes is a good thing, but sometimes you are hiding what you have to say. If you have something of merit to say, what you posted probably doesn’t fully capture that.

      Why I disagree thus far with what you posted: You compare ACT, a “Third-Wave” behavior therapy with much mainstream academic research behind it, to EST (Erhardt Seminars Training, a cult-like moneymaking “transformational” group from the 60s-80s that now manifests as Landmark Forum), and to Scientology, an infamous “New Religion” that is particularly well-known for their destructive litigation process against former members and critics. Wow!

      1. Third Wave behavior therapies such as ACT have little in common with EST and Scientology as far as how they were derived (EST and Scientology were both someone’s “brain children” and involved zero prior academic research to back up their claims), and 2. EST and Scientology are coercive in methods and interaction with the public; they have essentially nothing in common with Third Wave behavior therapies, which generally adhere to current standards of clinical ethics and law.

      If you are not just casually trolling me, please say a few more words to explain what you mean. I don’t want to close my mind to dissenting opinions, and I wonder if you have some more to say that could enrich this conversation rather than just nay-say whatever has already been said. As you can see, there is quite a bit of interchange here and dissent is encouraged, not suppressed. However just coming on and calling my approach a few names doesn’t cut it.

  • shagspur

    I googled “All psychotherapy is Bullshit” and arrived here. Excellent article.
    I am reading “Freud; The Making of an Illusion” by Frederick Crews, a book that provides the background that led to the bullshit that permeates modern psychology.
    I have also been studying the work of Tversky, Kahnmann, Dawes, and Dineen, four people in the profession (two of them deceased) who cut through the bullshit.
    I will be reading your posts, as it seems you also wish to cut through the bullshit, and you are apparently still alive. Thank you.

    • LOL “you are apparently still alive.” Yes, I think so! 😀

      I would say “Most psychology is mostly bullshit.”

      More generally stated, The Bullshit Factor:

      – The larger the unit of study (assuming increasing complexity of unit, not just physical size), the more bullshit in the science.

      – To wit: Particle physics–a bit of bullshit. Chemistry–a bit of bullshit. Biochem–a good chunk of bullshit. Biology–a fairly sizeable chunk of bullshit. Anatomy/physiology–quite a lot of bullshit. Behavioral science and psychology–mostly bullshit. Sociology–almost entirely bullshit. Macroeconomics and International Relations–pure, unadulterated bullshit, though some interesting observations at times.

    • Oh and PS thanks for your kind words. I do appreciate some of Freud’s writings, though in the 19th and early 20th Century it was especially hard not to spew forth utter bullshit. Kahnmann and Tversky are legendary and did wonderful work, winning the Nobel Prize for Economics, the only psychologists (that I know of) to have won any Nobel prize.

      • shagspur

        Here is more information on me and what I do. I play viola and teach people of all ages to play. I am certainly in the final third of my life which I am devoting to the idea that music is a hard science and that everything on the violin can be approached scientifically. Of course, most violin teaching is less than bullshit…. it is hopeless ignorance masquerading as knowledge, corrupted by sacred ideas, contradictions, superstitions, and wild emotional swings. Well, we are human, but middle C vibrates at 261.6 herz per second, regardless of how we feel about it. A violin, at its best, is a perfect acoustical machine; a viola, at its best, a woefully imperfect machine. Some aspects of music can be measured in physics as hard science: i.e. bow speed, distance from bridge, pitch ratios. Most of what we do is probabilistic; perhaps the finest aspect of music is that harmony in itself is a metaphor for people living happily together.
        I know nothing of ACT but I do use Alexander Technique, which I view as a study of habit with the aim of freeing ourselves from the negative behaviors that run our lives. It seems to me that habitual behaviors at both the level of persons and people cause most of our problems. So, anyone studying the practical aspect of how to behave has my vote. If ACT is supported by data, it might interest me on several levels. Thank you for reading.

        • Ha! Pleased to meet you. I spent time 2014-2017 with the Orchestra of Crafty Guitarists and learned some Alexander Technique in that context.

          Re ACT — yes, it has good data supporting it. Inasmuch as we can measure some things, it appears to be pretty good. Does depend upon who’s doing it and with whom — like all psychotherapy.


        • HH

          I bought a guitar off the shopping channel last week. All I could afford, but making music sounded like a great escape. I played piano as a child, and in the school band for a year.

          I took theater all the way through school, and one thing I never forgot is the definition of art: “Art is the expression of emotion by man, for an audience.” Through music, drama, painting, sculpting – whatever.

          Art has changed history. Art changes people. Art has helped form and overthrow nations. That single chord can reverberate through human history.