Is Therapy Overrated? ft. Psychologist Jonathan Shedler

Scott’s December ‘25 No Mercy / No Malice post, “The Cult of Therapy,” argued that therapy has been oversold as a cultural cure-all. In this Deep Dive, he tests that argument with Dr. Jonathan Shedler, a clinical psychologist and researcher best known for his work on the effectiveness of psychodynamic therapy. Dr. Shedler agrees with much of the critique, and goes further: most people who believe they’re in therapy, he argues, aren’t getting the kind of treatment that produces lasting change. They discuss when therapy is warranted, why economic suffering often isn’t a psychotherapy problem, what the gender imbalance among providers means for men, and why AI can’t substitute for a human therapist. Learn more about your ad choices. Visit podcastchoices.com/adchoices

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• 1:21Speaker 01

  Therapy has become less like medicine and more like a lifestyle purchase.

• 1:25Speaker 03

  Most of what's being promoted in the culture now as therapy is insta-therapy.

• 1:36Speaker 01

  Today's Prof G Plus deep dive is on therapy, what it does, what it doesn't do, and who's selling it. In December, I wrote a no mercy, no malice post called "The Cult of Therapy." My argument was the following. Therapy has become less like medicine and more like a lifestyle purchase, the emotional equivalent of a Birkin bag. I got real pushback, some of it even civil. Therapists wrote rebuttals. Psychology Today ran a response. The comment section on my own site turned into a genuine debate. Fair enough. I think that's actually probably a productive exercise. But the data still points in the direction of therapy having become an expensive Band-Aid for a larger problem. And that problem is economic. In America, the poorer you are, the more likely you are to be mentally ill.

• 2:21Speaker 01

  Below the poverty line, it's 29% of adults. At twice the poverty line and above, it drops to 21%. And there was an even more interesting piece of data in the post that I think is worth revisiting. A 2022 study of mental health videos on TikTok found 83% were misleading and only 9% came from creators with any relevant professional qualification. A newer study focused this year in PLOS1, focused specifically on ADHD content, found something even starker. Researchers had licensed psychologists review the top 100 TikTok videos under hashtag ADHD. Nearly half a billion combined views. Only 49% of the claims checked out.

• 3:06Speaker 01

  Just 20% of the creators shared any credentials and none were licensed psychologists, psychiatrists, or doctors. More than half had financial incentive, as in they were selling something tied to the video. So we have two different things wearing the same name. There's therapy, which happens in a room between two people, usually one who is licensed. And there's therapy, the content genre, self-diagnosis, boundaries, attachment styles, trauma, delivered in 30 seconds to three minutes by someone with a ring light, no license, and often a product to sell you. Of course, none of this is to say that therapy can't be and isn't useful.

• 3:47Speaker 01

  It is, especially for the 23% of American adults who experience mental illness. I said in the original piece, and I'll say it again here, the problem isn't therapy. It's the marketing of therapy as a prerequisite for a decent life and the 30-second version of it that's replaced the real thing in most people's feeds. And when you look at real therapy, meaning actual clinicians, actual patients, the evidence is stronger than people assume. One of the most consistent findings in psychotherapy research isn't about which technique works. It's about the relationship itself, what researchers call the therapeutic alliance, trust, a shared understanding of the goal, a real human bond.

• 4:29Speaker 01

  That's the variable that predicts outcomes more reliably, which tracks. A relationship is exactly the thing a TikTok video can't offer you, no matter how accurate the caption is. Which brings us to our guest. Dr. Jonathan Shedler is a clinical psychologist and researcher whose work has spent two decades making the case for what real psychotherapy actually is and does. And he too has been critical of what's replaced it online. He doesn't think the content is therapy either. So what is therapy and which parts of it are overrated? Let's ask Dr. Jonathan Shedler.

• 5:08Speaker 01

  Jonathan, thanks for joining us.

• 5:10Speaker 03

  Great to be here.

• 5:11Speaker 01

  So we wrote a piece arguing therapy has been oversold as a cultural cure-all. Where do you think we got that right and where did we get it wrong?

• 5:19Speaker 03

  Good question. You got some right and some wrong. Things are being way, way, way oversold. 100% right about that. Most of what's being oversold has very, very little to do with what I would consider to be legitimate psychotherapy. So I'd like to make a distinction between therapy culture on the one hand, which really comes from pop culture and internet influence culture, and legitimate psychotherapy. Most of what's being promoted in the culture now as therapy is really social media, internet, pop, insta-therapy.

• 6:02Speaker 01

  Yeah. My sense is that there's a lot, there's now an incentive system or an ecosystem to watch my, let me give you advice about therapy with a ring light or what passes as therapy. And that the cloud cover that is a general gestalt or argument that especially among young men, that all young men, before they get a job, before they engage in a relationship, or quite frankly, they do anything, they need to work on themselves with therapy. And my sense is, and I've said this, that I think a lot of the anxiety and a lot of the struggles young men are facing is a natural part of the economic struggles of a young man and that the greatest therapy bomb would be a detonation of more jobs and more venues for people to establish relationships.

• 6:47Speaker 01

  And that therapy's been kind of sold as a cure-all. While it can play a hugely important role, I'm not against therapy. It's been sold as a, like I said, a one size fits all that everyone, especially young men, need to work on themselves.

• 7:01Speaker 03

  Yeah, I actually largely agree with you, but I'd like to sharpen some of the points and some of the assumptions beneath that. Everyone should get therapy is just a meaningless statement. There's no such thing as therapy. There's therapy to solve a particular problem, a psychological problem at a particular, at a particular time for a particular purpose. There's no generic thing called therapy and there's no generic idea of working on yourself in some kind of nebulous unspecified way. Real psychotherapy has a purpose. And this is not coming from legitimate psychotherapists. This is coming from online influencers and pop culture.

• 7:46Speaker 03

  Everyone should go to therapy to work on themselves in some unspecified way. And that's not how you start therapy. That's not what real psychotherapy is about. So yeah, I agree. And I've heard you say, for example, one of the best things that you can do for your mental health, for men or for anyone really, is to have connections, to be involved in the world with other people, to make relationships. And it's really good advice. The people who need therapy can't benefit from, can't take that advice. What happens when somebody knows and understands?

• 8:26Speaker 03

  They would be much better off if they had social engagement with other people. And something inside them, something about their personal psychology gets in the way of that. So they can get the best advice in the world and they either can't take it in or they can't act on it because of internal conflicts or inhibitions or internal limitations that affect how they relate to other people. So the advice is good, but for one reason or another that is psychological in nature, that person can't act on the advice. That's when we start talking about therapy and it's not working on yourself.

• 9:07Speaker 03

  It's, you'd like to have better relationships with people. Something is getting in the way of that. Something about you is getting in the way of that. Let's see if we could understand what that's about and work to change that so that you can follow great advice.

• 9:25Speaker 01

  Yeah. I like that a lot and I want to double click on it because a lot of young men and women listen to this program. And I think that a lot of them would benefit from therapy and a lot of them are being sold a bill of goods and this notion that therapy is the base of all productive young adulthood or a pillar, which I don't believe is true.

• 9:50Speaker 03

  Yeah, I don't either.

• 9:51Speaker 01

  But how do you, but I look back to what you said. Okay, assume relationships are key and if something's getting in the way of those relationships, you may want to think about therapy. The problem I would have had as a young person was having, being thoughtful and self-aware enough to know that something was getting in the way of my relationships. Can you be a little bit more specific in terms of litmus tests or signals or signs that a young person can recognize that? That help them distinguish, or discern, or recognize when they would be a really good candidate for therapy.

• 10:27Speaker 03

  Yeah, often, I mean, there's infinite number of answers to that question, but let me home in on, you know, on something straightforward.

• 10:37Speaker 03

  You have an idea of what you want to do. There aren't external obstacles that prevent that from happening. You'd like to do it. And either something inside of you stops you from acting on it. Maybe you don't fully understand what that something is. But, you know, it's like each time you try to do it, something inside of you is working at cross purposes with the rest of you. You know, or, you know, you try to do it. You try to engage with people. You try to, you know, create connections and something keeps going wrong. And when something goes wrong, you know, once or twice or three times, you say, you know, well, bad luck, wrong person, didn't fit.

• 11:23Speaker 03

  When the same sorts of things keep going wrong over and over again, it's kind of a pattern. And you don't understand why it's happening, but you, you can see that it's, that it's a pattern. Then we start asking the question, well, is there something that you're doing in relationships? Is there something about, you know, how you see yourself or how you see the other person in a relationship? The relational patterns that you, that we all play out all the time with everyone? Is there something about our relational patterns that's getting in the way? When things like that are on the table, then we might start thinking about therapy. And once again, it's not generic therapy. I'm going to work on myself.

• 12:08Speaker 03

  It's you meet with the therapist. You spend a lot of time getting to understand this person's life as an individual and this person's interior world as an individual. And you, you home in together on some understanding about, you know, something about the person that leads them to trip over their own feet or that gets in their own way. And that becomes the focus of psychotherapy. So it's not generic psychotherapy to work on yourself. Now it becomes, can I understand and change what keeps getting in the way of having more meaningful connections with other people? And that's a starting point for doing meaningful work.

• 12:52Speaker 01

  I've argued that the quote unquote, mental health crisis is downstream, or a lot of it is downstream of economic precarity. From where you sit clinically, how much of what walks into your office is material circumstance versus something therapy is actually built to treat?

• 13:09Speaker 03

  You know, first of all, I agree with you. You know, I mean, individual, much individual suffering is downstream from other factors in the culture, cultural, economic, et cetera. One of the reasons there's so much bad therapy out there, and one of the reasons people are rightfully skeptical of therapy is that we continually ask psychotherapy to solve problems that are not psychotherapy problems, that are not psychological problems. So to use your example, you know, if somebody's not making an adequate living, if they're under financial stress, if they can't get their basic needs met, they are going, they are going to suffer for it.

• 13:54Speaker 03

  But if the factors that are causing that suffering are external, well, there, there isn't suitable employment available for them. You know, then we can have a lot of sympathy for their situation. It's a terrible place to be in. But if that's really the cause, and that's the full explanation for what's wrong, there's really nothing a psychotherapist can do. It's just flat out not a psychotherapy problem. Now, let's turn that around. Suppose there are external possible opportunities. Right? Suppose the person could have a more satisfying job. Suppose, you know, they could advance in their career, make more money, you know, get their basic financial needs met.

• 14:38Speaker 03

  And something about them, something about their own psychology is getting in their way of pursuing that. Now we have a problem that's suitable for psychotherapy. Right? What about you is stopping you from pursuing opportunities that might otherwise be open to you? And often it's often a complex interaction. There's external factors that affect or impinge on the person. There's internal psychological factors that exacerbate or amplify that, that makes things worse. So there's often a, you know, sort of complex reciprocal interaction between difficulties that originate in the, let's say, the external world

• 15:22Speaker 03

  and difficulties that originate in the internal world. But psychotherapy is meant to address the internal difficulties. And, you know, really, a patient comes to psychotherapy and they say, well, my problems are entirely due to, you know, things in my industry are terrible. I can't get a good paying job. Or my wife is a horrible person and I'm stuck in this marriage and there's nothing I can do about it. Or men are, men are awful and I can never find anyone that's suitable for me because that's how men are. An appropriate response from a psychotherapist is, if that's, you know, that's your full understanding of the problem, you know, I have great sympathy for you. I understand your suffering.

• 16:08Speaker 03

  There's very little as a psychologist that I can do to help. On the other hand, if you think that there's some way that you may have a role in these difficulties, that you may be contributing to these difficulties, then there's a great deal we can talk about here and many possibilities for, for how psychotherapy could help. So, you know, a really central understanding, you know, a dividing line between what I call real psychotherapy and a lot of other stuff that pretends to be therapy is that psychotherapy is aimed at changing something about ourselves. If that's not the purpose, you can call it therapy. You can attach the label therapy to it.

• 16:51Speaker 03

  But that's, that's not what psychotherapy is.

• 17:02Speaker 00

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• 19:06Speaker 01

  I think a lot about words and the way they're used. And I wonder if sometimes, and Jimmy Carr pointed this out, the great British comedian, that, all right, we say anxious, do we really mean worried? We say depressed, do we really mean sad? We use the word trauma when we're really talking about things that happen to a lot of us that are very upsetting, but we couch this, this language in an atmosphere of something that requires therapy as opposed to something that requires relationships and a healthy approach to life, based on the fact that we all face some version of these things at some point in our life. Your thoughts?

• 19:48Speaker 03

  Sure. These are human problems. Some of these things are simply part of the human condition. There's something embedded in what you said that I think is important to disentangle. We live in a culture now where this kind of therapy speak is everywhere, and everything is couched. Nobody's had a disagreement, they got gaslighted, nobody's upset or irritated, they're traumatized. Nobody in the person's life is a difficult person to deal with, they're a narcissist or a toxic narcissist, narcissist, all this therapy speak. And I want to make two points.

• 20:29Speaker 03

  I keep reading, and I saw it in one of your, in one of your posts, that this language, this therapy language has somehow escaped from the consulting room and has become pervasive in culture. So the first point, this language didn't escape from the therapy consulting room. This is not the language of any legitimate bona fide therapy tradition. This is the language of pop culture and internet influence culture. It's not the language of psychotherapy. And everybody, including thoughtful, critically thinking, educated people, it's so pervasive

• 21:14Speaker 03

  that people are misunderstanding this to be the language of psychotherapy. And it's really not. And you could line up 100 online therapy influencers on your show, and they'll tell you something different. But when you narrow it down to the people who are not performatively playing the role of expert on social media, people who are legitimate experts, they'll tell you, this language, most of it doesn't come from any therapy tradition. And the terms that do come from psychology and psychiatry are being wildly misused. That's the first point.

• 21:52Speaker 03

  The second point I want to make is talking about ourselves in these sort of cultural cliches and abstractions. I have trauma, I have an anxiety disorder. On the one hand, they're trying to communicate an internal experience. So in that sense, they're helpful. But they're also a defense. The language is a defense against looking at the specifics and the particulars of our own experience and our own internal life. They're really contemporary, newish ways of speaking in cliches.

• 22:33Speaker 03

  And when we talk about ourselves, cliches and generalities are always a defense against going more deeply into what our experience is. So if somebody comes to a skilled therapist and says, I'm here because I'm suffering from depression, or I'm here because I have an anxiety disorder, there's really only one competent response from the therapist, which is some version of, tell me about that. Help me understand what you're experiencing. Maybe the person says, well, I'm depressed, you know what depression is, I have the symptoms. What's the treatment for depression?

• 23:14Speaker 03

  And I would respond by saying, well, the word can mean a lot of different things to a lot of different people. Everybody experiences it differently. I'm really interested in understanding your experience. Tell me more about it. Help me understand how that shows up in your life. Walk me through a typical day when you're feeling really depressed. What's that like? And we're going to think together. What led up to it? What preceded that? What follows it? What are the thoughts and feelings that accompany that? So it's a fundamental principle of, we could call insight oriented or exploratory therapy or talk therapy, that we move from the general to the personal and the specific.

• 23:57Speaker 03

  And if the discussion stays at the language of these sort of cultural tropes and therapy speak, and the therapist goes along with it, the therapist is really colluding in a defense. It's not therapy. It takes the place of doing real psychotherapy.

• 24:16Speaker 01

  So we talk a lot about the struggles facing young people, specifically young men on the show. And women are twice as likely to receive mental health treatment in a profession where three quarters of the providers are women. Is there legitimacy to the notion that the sector has been feminized and may not be as responsive or adept at addressing the unique concerns and struggles of men, just as women have unique concerns and struggles? Has the profession been feminized to the detriment of treating young men?

• 24:49Speaker 03

  Well, I think anytime you see that level of imbalance in any profession, it necessarily shapes the culture of the profession in ways that I don't think make for a vital discipline based on critical thinking, exchange of ideas, and so on. So I think lopsided is a difficulty. But I think that's embedded in actually a much larger difficulty. And I know I'm going to get hated on for saying this in public, but so be it.

• 25:29Speaker 03

  The therapy professions have been in freefall for 20-plus years. Much of what's being offered in the name of therapy these days is not skilled, expert psychotherapy. It's something else. And I mean, what you say about the imbalance in the profession is true, but your conclusion men aren't getting good therapy, or there's a mismatch between therapy culture and what men need, I would say the problem is actually bigger. It's not just that men aren't getting therapy. It's that most people aren't getting good therapy.

• 26:14Speaker 03

  Good therapy defined as something that changes something fundamental about ourselves. It's not soothing, it's not a feel-good balm, it's not helping you be in a better mood. It's not like a feel-good emotional massage. Therapy starts with the premise, there is something about you as a person that's getting in your own way or causing unnecessary suffering or limitation. The purpose of our work is to understand what that something is and help you change that so that you can live a more satisfying and more useful life.

• 26:57Speaker 03

  If that's not what's happening, it's not meaningful therapy. And for a lot of reasons, and we could spend the whole episode and 10 more episodes talking about why, most people who think they're going to therapy and think they're getting therapy are not getting that at the risk of repetition. It's not just that men aren't getting access to good therapy. It's that a lot of people in general are not getting access to good therapy.

• 27:30Speaker 01

  I invested in a company that does, that up skills corporations for AI. And they did a big survey of how people in the workplace were using AI. And the number one use case could loosely be called therapy. And I realize I'm overusing that word, but some sort of therapy or companionship. Well, first off, not everyone has the resources to access really vital, thoughtful, effective therapy. And so I want to take the what could go right side of this. Can people benefit? Is there an upside potentially to AI with respect to helping people who might not have access to good therapy?

• 28:10Speaker 01

  Or is it kind of clumsy and leading people down the wrong road and more harm than good?

• 28:16Speaker 03

  For people who actually could benefit from real psychotherapy, and it takes the place of that, then I think, I think it's more likely to do harm. And let me be really specific about the preconditions necessary for therapy to happen. AI might provide something that's genuinely useful to people. Lots of things are useful to people in all kinds of ways. But it can't be useful as a psychotherapist, and for a very specific reason. The precondition for meaningful therapy, the precondition for knowing, coming to

• 28:57Speaker 03

  know those parts of ourselves that we don't initially know, and they get in our ways and that cause problems. The precondition for that is exploration in the context of a human relationship. The difficulties that are invisible to us in our day, as we go about our day-to-day lives, become manifest in a relationship with another human being. That's where they become visible to the psychotherapist, because the psychotherapist is participating in it and living the relationship. Secondly, we're biologically wired for attachment. We're mammals.

• 29:39Speaker 03

  Of all of the mammals on the face of the planet, humans have the longest period of dependency on caretakers, by far. So we're biologically wired to attach to other humans, initially to caretakers. This is scientifically grounded information. I'm not just spouting personal opinion here.

• 30:06Speaker 03

  The precondition for emotional learning and emotional change, for changing ingrained patterns about who we are, rooted in our emotional life, is a certain kind of attachment security that comes from a bond with another human being. There's something called an attachment system. And we're biologically wired to have this attachment system. In order for emotional learning to take place, you have to activate that attachment system and create a kind of attachment security. That's the precondition for the kind of learning

• 30:50Speaker 03

  that takes place specifically in psychotherapy. If you take the human attachment out of the equation, it can't happen. So what can you learn from a machine? You can learn intellectually. You can learn cognitively. You can learn a lot. But it's not the kind of emotional learning and growth and change that happens in a psychotherapy relationship based on a human attachment. And that's what AI is the coolest thing. And I play with it all the time and I use it for some work. It's super cool. It can do amazing things. But the people who are so into AI and saying, this is going to bring psychotherapy

• 31:34Speaker 03

  to tens of millions of people who couldn't otherwise access it, they're missing what psychotherapy is about and the fundamental psychological principles of what's required for the kind of change we're talking about. So, short question, long answer. But I hope that shed some light on it.

• 31:53Speaker 01

  Yeah, I always think of it as one of the keys, I would imagine, to good therapy is the relationship and the bond you establish with someone in person. And they get to know you and you get to trust them. And you get a sense that this person is invested and understands the nuance of my situation. And I feel safer around them. And my blood pressure goes down, being in their physical presence, all those things that soften the beach for you to learn.

• 32:18Speaker 03

  Yeah, two things go wrong when you try to do therapy. One is you don't have that bond. And you try to create psychological change, and it's not going to work. The other thing that goes wrong in therapy is you have that bond. This is therapy culture. This is pop psychology, insttherapist influence culture. You have that feel-good bond, and that's the entirety of it. And it's not working for change. So, yeah, you need exactly that kind of connection and that kind of bond that you described. But that bond isn't an end in itself. That bond is the necessary vehicle

• 33:00Speaker 03

  to work toward deeper self-understanding and toward psychological change.

• 33:06Speaker 01

  Jonathan Sheddler is a clinical psychologist, researcher and professor at UCSF. He is best known for his work on the effectiveness of psychodynamic therapy. Jonathan, Dr. Sheddler, thank you for joining us.

• 33:17Speaker 03

  It's been a pleasure. Thank you.

• 33:23Speaker 00

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