What is it about?
There are over 500 documented forms of therapy, with new ones emerging every year. However, this proliferation of therapeutic models has not led to significantly improved outcomes. And while access to psychotherapy increased over the past decades, this has not resulted in a reduced prevalence of mental health conditions within the general population. Recent meta-analyses, accounting for study quality and biases, confirm the limited effectiveness of psychotherapy in alleviating psychological problems. Despite this, many researchers, developers, and providers of psychotherapy continue to advocate for "more psychotherapy" and additional research to create better therapies. While acknowledging that psychotherapy benefits some individuals, we propose that instead of focusing on expanding psychotherapy, prioritizing primary prevention strategies offers a more promising approach to addressing the growing burden of mental suffering in society.
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Why is it important?
Shifting the focus away from individual therapy could make room for primary prevention strategies that address the long-neglected social determinants of mental ill-health: poverty, inadequate housing, social injustice, discrimination, exclusion, and related factors. Individual psychotherapy places the responsibility for mental suffering on the individual, allowing society to ignore systemic issues and framing mental health struggles as personal weaknesses rather than consequences of marginalization and inequality. This individual-centric approach persists partly because there is little incentive for stakeholders to study or promote healthier societal contexts. There are few employment opportunities focused on “diagnosing” and addressing harmful contexts. In contrast, the therapy industry has established substantial financial and intellectual interests in the status quo. Institutions and jobs are built around the assumption that talking to a professional stranger effectively reduces mental health problems. In addition, unlike research into contextual primary prevention solutions, research comparing the effectiveness of therapy A to intervention B aligns well with the popular randomized controlled trial (RCT) model and is more likely to secure funding. The status quo may also be convenient for policymakers, as it allows them to deflect the consequences of inadequate policies onto individuals and the mental healthcare system. However, because psychotherapy alone fails to address the rising burden of mental health issues, it is critical to look beyond individual interests and collaborate on broader societal changes.
Perspectives
In my opinion, it is crucial to provide people with accurate information about what they can realistically expect from psychotherapy, especially now that we are increasingly recognizing the potential for iatrogenic effects. Before entering a treatment program, one should know that more than 5 individuals have to follow the treatment for one of them to benefit. Furthermore, I am deeply troubled by the practice of assigning disorder labels and offering individual treatments to people who are simply responding normally to adverse circumstances. This approach implies that the individual is the problem, rather than their distressing environment. It was a great pleasure to work with Sami Timimi on his article and I hope our effort contributes, even in a small way, to a shift towards prioritizing the role of societal contexts in addressing mental health issues.
Laura Batstra
University of Groningen
Read the Original
This page is a summary of: Is more psychotherapy a dead horse? An essay on the (in)effectiveness of individual treatment for mental suffering, PLOS Mental Health, December 2024, PLOS,
DOI: 10.1371/journal.pmen.0000194.
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