I have been sitting with this piece and the responses to it.
I find myself curious about your data here. Are you drawing primarily from personal clinical experience, consultation work, research, or some combination of all three? I ask with genuine interest. Those of us who supervise and mentor clinicians are often looking at similar questions from different vantage points, and clarity about what informs a claim helps move the conversation forward.
Many of the clinicians I mentor are actively seeking what you describe as “real psychotherapy.” They are not trying to be friends, coaches, or influencers. They are trying to understand transference, enactment, resistance, and what it actually requires to sit with another human being without rushing toward reassurance or advice. What they often lack is not seriousness or commitment, but training environments that make this kind of work sustainable. High caseloads, brief treatment models, productivity demands, insurance constraints, and limited access to their own long-term therapy all shape what early career clinicians can and cannot practice.
This is where I find myself wanting more context in essays like this. Naming a problem without engaging the realities of contemporary training and practice risks turning a complex professional landscape into a simple character judgment about individual therapists. It can land less as an invitation to deepen the work and more as a sweeping indictment of a field that is already under strain. Many clinicians are practicing inside systems that reward speed, manualization, and symptom reduction. They are trying to learn depth work in environments that often do not support it.
In my consultation groups, there is real hunger for rigorous, relational, psychodynamic, and integrative thinking. There is also humility. Most newer clinicians know they are still learning. They want supervision that challenges them and frameworks that move beyond surface-level “helping.” They are asking serious questions about what psychotherapy actually is and how to do it responsibly.
So I am interested in continuing this conversation with attention to both skill and structure. What does it take to train therapists well right now? What conditions allow clinicians to move beyond the “lay helper” phase you describe? And how do we talk about standards while also acknowledging the systems shaping contemporary practice?
These feel like worthwhile questions for the field to keep engaging together.
I agree with you—most trainees are serious, well-intentioned, and hungry for quality training. But few are getting that training, or even know where to find it. Why their graduate programs and training sites are failing them is a whole other topic, and one I plan to comment on in future essays.
In this era of widespread mistrust of healthcare providers, I think we have to be careful about how we speak about our field and about one another. Broad claims about “most therapists” not really doing therapy contribute to stigma and confusion unless they are grounded in clear, accurate evidence.
If someone is going to argue that most therapists are not actually providing therapy, I genuinely want to understand how they are defining therapy. What counts? What does not?
As someone trained psychodynamically, I could happily debate models and meanings of therapy all day. But when we speak in sweeping generalities about an entire field, people who are already ambivalent or frightened about seeking help are the ones who absorb that messaging.
People should be frightened. The takeaway here is not that people should avoid therapy. The takeaway is that people should inform themselves about what good psychotherapy is and isn’t, and be careful who they choose.
Fear is not the same as discernment, and it is not the same as having access.
When people are operating from fear, especially fear shaped by stigma or past harm, they rarely make wise or well-supported healthcare decisions, even when options technically exist. Research in JAMA Psychiatry and related journals has repeatedly shown that fear of healthcare systems and mental health stigma significantly reduce help-seeking and delay care, often worsening outcomes. This is a fact.
So yes, people deserve choice. But we also have to be honest about how fear and stigma distort what feels possible.
I think you’re looking at this through a lens that feels incomplete to me, and potentially harmful in its impact. So yes, we see this differently. But I want to be clear about what I am actually addressing.
My concern is responsible authorship and how broad, unqualified claims about therapy or therapists can contribute to stigma, especially in a climate where mistrust of healthcare is already high. Words shape public perception.
Jonathan, I think you just bumped into the theoretical mess clinical practice and it's well intentioned yet perhaps unskilled practicioners bring to an endevour such as psychotherapy...which, in my 30 years experience is more akin to a very subtle art, yet with a very clear and specific intention.
Not to interject too much in your discussion, but I can't help but think about these quotes from Dr. Insel's book Healing.
"The real key to improving quality is accountability, gained by measuring outcomes and learning from results.
In the absence of measurement, confidence soon outpaces competence. Imagine managing hypertension without monitoring blood pressure, we're treating diabetes without measuring blood sugar. [...] But objective measurement of symptoms or outcomes has never been part of the mental health landscape.
Only 18% of psychiatrists and 11% psychologists in the United States routinely administer symptom rating scales to patiets to monitor improvement. In the absence of measurement, clinicians have not been accountable for specific outcomes.
In other areas of medicine, insurance companies enforce standards before they reimburse for services. They enforce accountability. But much of mental health care is paid directly out of pocket by consumers, so there is less oversight for quality."
And: "To put this disconnect in perspective, let's look at breast cancer. What if I told you that 90% of the professionals treating this disease had no medical training and that more than 60% of these non medically trained clinicians had not been taught the few interventions that we know actually work. This would seem a cruel joke. And one would hardly expect that this workforce would be capable of helping the 250,000 women who will be diagnosed with breast cancer this year.".
I think there could be more data in Jonathon's article, but I think he's right that it's a nightmare out here for crazy people like me. I was misdiagnosed with GAD for 13 years, but what I actually have is OCD. I saw 7 therapists, they all got it wrong, and the only intake form I ever got was the Beck. I had to figure it out myself, research treatment, and find someone who could actually provide ERP. I scored severe on the YBOCs. This is anecdotal, but many of my friends are also unsure of what therapy is doing, and many friends have struggled to get the right diagnosis.
I agree that a claim about "most" therapists is risky without statistics. That's why my critique, which is quite similar to Shedler's, refers to misleading messages on social media, corporate messaging, and the zeitgeist.
Social media abounds with messages from licensed therapists, unlicensed coaches, and others that equate "therapy" with anything that makes a person feel good in the moment. Companies like BetterHelp advertise "taking a break for yourself"—because that's easier to sell than psychotherapy. And you cite perfect examples of how the zeitgeist works against us: High caseloads, brief treatment models, productivity demands, insurance constraints, and so forth.
It's a multifaceted problem: the primacy of symptom-focused treatments like CBT and medications, cultural preference for quick and easy fixes, the commodification of health care, funding and messaging of NIMH and our professional organizations, etc etc. Of course, if you are psychodynamically trained and working in a setting with that orientation, your trainees will be interested in "transference, enactment, resistance, and what it actually requires to sit with another human being without rushing toward reassurance or advice." Mine are too. But do you imagine that's the norm now?
I don't think internal critique of our field scares patients away any more than the existing chaos already does. Traditional psychotherapy has a branding problem. Much of the public considers it old-fashioned and not "evidence based." It's incumbent on us to correct that misperception, as changes to social media, corporate messaging, and the zeitgeist can only come from a public that values us.
Yup. Thank you for bringing BetterHelp and similar platforms into this discussion. They are part of the current landscape whether we like it or not.
I do not know what the broader norm is at this point. (Some of this, I think, has to do with what population folks are working with, time and money. New clinicians do not have the income to pay for the training they may want. For example, my psychodynamic training cost me thousands each year and about four hours per week for a decade. I could not afford it now even at this point in my career.) I can only speak from the vantage point of where I have trained, where I have worked, and the clinicians who seek out consultation with me now. I have been out of hospital-based outpatient work since 2009, but when I was there the level of rigor and supervision in that particular clinic was significant. In many ways, it now feels like one of the last places where intensive psychotherapeutic training was still happening alongside direct clinical work. The Brattleboro Retreat, where i was for example, has a long history as a strong training ground. I can name about a dozen places like BR that I know of. I cannot speak to what is happening there now. (My mentors have mostly all retired or are working much less.) I left when supervision hours for my staff were going to be reduced and billing expectations began to move in a direction that, in my view, was not compatible with sustainable, high-quality care. Again this goes back to the economic drivers of care in the US.
BetterHelp, I cannot even begin to comment on that in any authoritative way. (But I have a string of cuss words for these platforms. And is something better than nothing?) I do not know what the internal expectations are for clinicians or what the supervision structures look like. What I can say is that the rise of large, for-profit, technology-driven mental health platforms, like Ellie - let's throw them in here too - is part of a much larger shift in healthcare and in higher education that deserves careful attention. (Generally, I am suspicious of a business person starting a for profit mental health clinic. Every Ellie office I have encountered is owned by a person without mental health training. Yuck. I don't know if that is generally true.)
I find myself wondering about the rapid increase in for-profit graduate programs preparing mental health providers starting around the 2000 and how expanded accessibility intersects with admissions practices that may, in some cases, lower entry standards. Increased access to training is important. At the same time, when programs are heavily tuition-driven there can be pressure to admit more students without always ensuring the level of preparation or clinical support needed for rigorous work. I do not have data to support this. What I have is a long view. I began noticing a shift in the early 2000s in the preparation of some graduates entering the field. Writing that sentence makes me feel old...
I know other writers in this space have some different ideas about this issue. Hoping more writing will be forthcoming.
This is not only an internal professional conversation. Potential clients are reading these exchanges as well. If this were a closed academic journal, I might frame some of this differently. We may simply have different expectations about what this space is for, which is fair. Public writing about psychotherapy carries different responsibilities than peer-to-peer discussion in private settings.
And do not get me started on corporate messaging in mental healthcare.
Our field has always evolved in response to cultural and economic pressures, and it will continue to do so. The challenges we are naming now will keep shifting as mental healthcare itself continues to evolve.
And there is some embedded elitism in all I have written about here. Another topic, another essay.
Thank you for your comments here and in your brief article "Therapy That Isn't Psychotherapy." It provided clarity regarding dynamics I had sensed but was unable to properly name. I think there is a distinction between honing the skills necessary to be a sound, credible therapist for a person seeking help and therapeutic culture, which places heavy emphasis on what the zeitgeist demands and sells as mental health. Of course, I recognize there is more to it than this simple bifurcation, but it provides some basis, at least for me, to get my bearings. Practically, this means I will pursue additional therapeutic training as my graduate education / curriculum was marked by considerable redundancy (e.g., a steady diet of trauma, "evidence-based" treatments and soup de jure modalities). Dr. Shedler's posts help too!
I agree with you, and I've written about my concerns about this "real" or "not real" psychotherapy. One would have to watch "most therapists" to make such a claim, or at least cite one piece of evidence.
When looking at training schools, not a single one appeared to be training people in this ‘lay person’ helping style.
Perhaps there is another level of psychotherapy training I’m not aware of. I’d be surprised if a therapist with this working model would be accepted as a member of the UKCP (the governing body my college belongs to).
I also agree with the comments about this posts sweeping statement and generalisations.
Perhaps more specificity would be useful.
I know you’ve made posts about what a bad therapist is, and also a good therapist. But it’s common for Substack posts to live in isolation.
I am not in a position to speak to training in the U.K. But one thing I do know is that programs that offer poor training all represent themselves as offering the highest quality training—especially to prospective applicants.
I’m still stunned by the fact that many of my peers during training had not had any psychotherapy themselves, nor was it insisted upon by the (prestigious) university. I’ve learned as much from the two excellent psychotherapists who’ve treated me over the last 20 years as I did /do from years of training and ongoing supervision.
I believe this is in part about engaging in the art of confrontation in a manner that is empathetic and being able to sustain the process of building a relationship despite the challenges.
I can’t give this a proper answer, but if you read back through Jonathan’s Substack articles (most are quick reads) I think you will get a better feel for what he means here.
In my own words, a lot of therapists provide “validation therapy” and their clients begin to feel better and move on. But real therapy involves examining patterns of relating and becoming aware of your own mal adaptive patterns. This awareness opens the door to choosing healthier ways of showing up in relationships.
A colleague called this "How-Ya-Doin'" therapy. Unfortunately it is rampant. This fact is a statement about the power of the inner minds of both participants to hold onto what is comfortable. I agree with Erika, below. The real discussion is about what constitutes "real therapy." Ultimately, it has to be measured by the results.
Great piece - thank you. The increased use of AI as therapy and companionship can make our work as therapists most challenging. AI offers constant "validation"; while psychotherapy requires friction (within a safe container). The therapist must be comfortable with discomfort, both that of the client, and the one in themselves when challenging moments arise.
My most import mentor once gave me an unforgettable zinger. It was intended to sting such that I wouldn't forget it. "If you would stop trying to be so damn helpful maybe you could finally freaking help somebody" [leaves room].
Nice. Thought this paired well with the last article, about moral education. I always thought the moral-educators-as-“therapists” were implicitly accepting that they’re unable or unwilling to engage in real psychotherapy, so they’re instead telling people what to think or telling people they’re right or wrong for thinking the way they do. As if that’s an acceptable alternative to meaningful psychotherapy. Really gets my goat.
I think it may be easy for the therapist to feel rewarded in making other’’ feel good, and they end up doing cycles of “feel-good” sessions week after week. In reality, this is the antithesis to the beginning of growth/healing one’s psychological struggles.
I find your thoughts on some modern therapy and therapists interesting. This could be a good panel or dialogue discussion as part of a didactic conversation among professionals, let me know if you’d be interested in collaborating. I am a limited, licensed psychologist practicing in Michigan, I trained in a psychoanalytic psychodynamic program and have been a psychoanalytic patient for almost 20 years, the way I practice includes that, but is not in any way traditional psychoanalysis or psychodynamic, I’m interested in your thoughts about the rise of quasi therapy and quasi therapist on social media, it would be an interesting discussion.
I agree with you on many points, particularly when in the wild West of Instagram and TikTok there are non-licensed untrained people positioning themselves as experts are professionals, however, I also wonder if it’s a scenario where the genie is out of the bottle, visa V social media, and if there are benefits to this sort of thing, normalizing, deep path, authorizing, and in some way, inviting younger people into a space in which they may pursue whatever type of therapy genuinely becomes helpful for them.
Anyway, could be a long and interesting conversation, I don’t know if you have a podcast, but if you do, I will give it a listen. 🙏
I love that this is being brought up! I agree that there is a fundamental, relational element being left out of a lot of training on how to be a therapist.
AND
I can imagine if I read this, as someone who was so passionate about their work as a therapist and had trained hard and done exactly what they had been taught, and then I read that I’m missing something vital to doing “real” therapy?
That’s scary.
My defenses go up.
It’s hard to take in any information when I’m in that mode.
This makes me wonder how often we mistake comfort for change. Therapy that feels good in the moment is not always the therapy that transforms patterns.
As a new AMFT, this resonates. My graduate program did a good job offering a buffet of modalities — which is something I appreciated — but now that I am seeing clients, I feel myself having conflicting impulses about what I want to do in the room. I want more training.
But my understanding is that psychodynamic treatment outcomes aren’t significantly
different than other types of therapy? There could be pitfalls with a mishmash / DIY approach (that’s what I’m currently experiencing), but could one be trained in CBT or somatic work and still help people? Is psychodynamic the only or best way? Maybe you’re articulating a different concern.
On a side note, I’ve recently discovered your work on YouTube and this Substack. I find it helpful as I try to make my way here. Thanks for sharing your perspective with the public. I genuinely appreciate it and find it helpful.
This is a strong claim. I’m curious what evidence you’re drawing on when you say “most therapists” remain in the lay helper phase. Are you referencing outcome research, supervision studies, or training data?
Given the scope of the statement, I’d genuinely be interested in seeing the empirical grounding behind the conclusion that meaningful psychotherapy is increasingly rare.
Yes to this. I realize research can't explain everything and has its limits, but sweeping statement without proof feel very dangerous to me. Opinions matter, but there is danger in framing opinion as fact....
I have been sitting with this piece and the responses to it.
I find myself curious about your data here. Are you drawing primarily from personal clinical experience, consultation work, research, or some combination of all three? I ask with genuine interest. Those of us who supervise and mentor clinicians are often looking at similar questions from different vantage points, and clarity about what informs a claim helps move the conversation forward.
Many of the clinicians I mentor are actively seeking what you describe as “real psychotherapy.” They are not trying to be friends, coaches, or influencers. They are trying to understand transference, enactment, resistance, and what it actually requires to sit with another human being without rushing toward reassurance or advice. What they often lack is not seriousness or commitment, but training environments that make this kind of work sustainable. High caseloads, brief treatment models, productivity demands, insurance constraints, and limited access to their own long-term therapy all shape what early career clinicians can and cannot practice.
This is where I find myself wanting more context in essays like this. Naming a problem without engaging the realities of contemporary training and practice risks turning a complex professional landscape into a simple character judgment about individual therapists. It can land less as an invitation to deepen the work and more as a sweeping indictment of a field that is already under strain. Many clinicians are practicing inside systems that reward speed, manualization, and symptom reduction. They are trying to learn depth work in environments that often do not support it.
In my consultation groups, there is real hunger for rigorous, relational, psychodynamic, and integrative thinking. There is also humility. Most newer clinicians know they are still learning. They want supervision that challenges them and frameworks that move beyond surface-level “helping.” They are asking serious questions about what psychotherapy actually is and how to do it responsibly.
So I am interested in continuing this conversation with attention to both skill and structure. What does it take to train therapists well right now? What conditions allow clinicians to move beyond the “lay helper” phase you describe? And how do we talk about standards while also acknowledging the systems shaping contemporary practice?
These feel like worthwhile questions for the field to keep engaging together.
I agree with you—most trainees are serious, well-intentioned, and hungry for quality training. But few are getting that training, or even know where to find it. Why their graduate programs and training sites are failing them is a whole other topic, and one I plan to comment on in future essays.
In this era of widespread mistrust of healthcare providers, I think we have to be careful about how we speak about our field and about one another. Broad claims about “most therapists” not really doing therapy contribute to stigma and confusion unless they are grounded in clear, accurate evidence.
If someone is going to argue that most therapists are not actually providing therapy, I genuinely want to understand how they are defining therapy. What counts? What does not?
As someone trained psychodynamically, I could happily debate models and meanings of therapy all day. But when we speak in sweeping generalities about an entire field, people who are already ambivalent or frightened about seeking help are the ones who absorb that messaging.
People should be frightened. The takeaway here is not that people should avoid therapy. The takeaway is that people should inform themselves about what good psychotherapy is and isn’t, and be careful who they choose.
Wow. We see this very differently.
Fear is not the same as discernment, and it is not the same as having access.
When people are operating from fear, especially fear shaped by stigma or past harm, they rarely make wise or well-supported healthcare decisions, even when options technically exist. Research in JAMA Psychiatry and related journals has repeatedly shown that fear of healthcare systems and mental health stigma significantly reduce help-seeking and delay care, often worsening outcomes. This is a fact.
So yes, people deserve choice. But we also have to be honest about how fear and stigma distort what feels possible.
I think we are no longer talking about the same thing, and I’ll leave it there.
I think you’re looking at this through a lens that feels incomplete to me, and potentially harmful in its impact. So yes, we see this differently. But I want to be clear about what I am actually addressing.
My concern is responsible authorship and how broad, unqualified claims about therapy or therapists can contribute to stigma, especially in a climate where mistrust of healthcare is already high. Words shape public perception.
That is the issue I am raising.
Jonathan, I think you just bumped into the theoretical mess clinical practice and it's well intentioned yet perhaps unskilled practicioners bring to an endevour such as psychotherapy...which, in my 30 years experience is more akin to a very subtle art, yet with a very clear and specific intention.
BTW - This is a fact!
Not to interject too much in your discussion, but I can't help but think about these quotes from Dr. Insel's book Healing.
"The real key to improving quality is accountability, gained by measuring outcomes and learning from results.
In the absence of measurement, confidence soon outpaces competence. Imagine managing hypertension without monitoring blood pressure, we're treating diabetes without measuring blood sugar. [...] But objective measurement of symptoms or outcomes has never been part of the mental health landscape.
Only 18% of psychiatrists and 11% psychologists in the United States routinely administer symptom rating scales to patiets to monitor improvement. In the absence of measurement, clinicians have not been accountable for specific outcomes.
In other areas of medicine, insurance companies enforce standards before they reimburse for services. They enforce accountability. But much of mental health care is paid directly out of pocket by consumers, so there is less oversight for quality."
And: "To put this disconnect in perspective, let's look at breast cancer. What if I told you that 90% of the professionals treating this disease had no medical training and that more than 60% of these non medically trained clinicians had not been taught the few interventions that we know actually work. This would seem a cruel joke. And one would hardly expect that this workforce would be capable of helping the 250,000 women who will be diagnosed with breast cancer this year.".
I think there could be more data in Jonathon's article, but I think he's right that it's a nightmare out here for crazy people like me. I was misdiagnosed with GAD for 13 years, but what I actually have is OCD. I saw 7 therapists, they all got it wrong, and the only intake form I ever got was the Beck. I had to figure it out myself, research treatment, and find someone who could actually provide ERP. I scored severe on the YBOCs. This is anecdotal, but many of my friends are also unsure of what therapy is doing, and many friends have struggled to get the right diagnosis.
I agree that a claim about "most" therapists is risky without statistics. That's why my critique, which is quite similar to Shedler's, refers to misleading messages on social media, corporate messaging, and the zeitgeist.
Social media abounds with messages from licensed therapists, unlicensed coaches, and others that equate "therapy" with anything that makes a person feel good in the moment. Companies like BetterHelp advertise "taking a break for yourself"—because that's easier to sell than psychotherapy. And you cite perfect examples of how the zeitgeist works against us: High caseloads, brief treatment models, productivity demands, insurance constraints, and so forth.
It's a multifaceted problem: the primacy of symptom-focused treatments like CBT and medications, cultural preference for quick and easy fixes, the commodification of health care, funding and messaging of NIMH and our professional organizations, etc etc. Of course, if you are psychodynamically trained and working in a setting with that orientation, your trainees will be interested in "transference, enactment, resistance, and what it actually requires to sit with another human being without rushing toward reassurance or advice." Mine are too. But do you imagine that's the norm now?
I don't think internal critique of our field scares patients away any more than the existing chaos already does. Traditional psychotherapy has a branding problem. Much of the public considers it old-fashioned and not "evidence based." It's incumbent on us to correct that misperception, as changes to social media, corporate messaging, and the zeitgeist can only come from a public that values us.
Yup. Thank you for bringing BetterHelp and similar platforms into this discussion. They are part of the current landscape whether we like it or not.
I do not know what the broader norm is at this point. (Some of this, I think, has to do with what population folks are working with, time and money. New clinicians do not have the income to pay for the training they may want. For example, my psychodynamic training cost me thousands each year and about four hours per week for a decade. I could not afford it now even at this point in my career.) I can only speak from the vantage point of where I have trained, where I have worked, and the clinicians who seek out consultation with me now. I have been out of hospital-based outpatient work since 2009, but when I was there the level of rigor and supervision in that particular clinic was significant. In many ways, it now feels like one of the last places where intensive psychotherapeutic training was still happening alongside direct clinical work. The Brattleboro Retreat, where i was for example, has a long history as a strong training ground. I can name about a dozen places like BR that I know of. I cannot speak to what is happening there now. (My mentors have mostly all retired or are working much less.) I left when supervision hours for my staff were going to be reduced and billing expectations began to move in a direction that, in my view, was not compatible with sustainable, high-quality care. Again this goes back to the economic drivers of care in the US.
BetterHelp, I cannot even begin to comment on that in any authoritative way. (But I have a string of cuss words for these platforms. And is something better than nothing?) I do not know what the internal expectations are for clinicians or what the supervision structures look like. What I can say is that the rise of large, for-profit, technology-driven mental health platforms, like Ellie - let's throw them in here too - is part of a much larger shift in healthcare and in higher education that deserves careful attention. (Generally, I am suspicious of a business person starting a for profit mental health clinic. Every Ellie office I have encountered is owned by a person without mental health training. Yuck. I don't know if that is generally true.)
I find myself wondering about the rapid increase in for-profit graduate programs preparing mental health providers starting around the 2000 and how expanded accessibility intersects with admissions practices that may, in some cases, lower entry standards. Increased access to training is important. At the same time, when programs are heavily tuition-driven there can be pressure to admit more students without always ensuring the level of preparation or clinical support needed for rigorous work. I do not have data to support this. What I have is a long view. I began noticing a shift in the early 2000s in the preparation of some graduates entering the field. Writing that sentence makes me feel old...
I know other writers in this space have some different ideas about this issue. Hoping more writing will be forthcoming.
This is not only an internal professional conversation. Potential clients are reading these exchanges as well. If this were a closed academic journal, I might frame some of this differently. We may simply have different expectations about what this space is for, which is fair. Public writing about psychotherapy carries different responsibilities than peer-to-peer discussion in private settings.
And do not get me started on corporate messaging in mental healthcare.
Our field has always evolved in response to cultural and economic pressures, and it will continue to do so. The challenges we are naming now will keep shifting as mental healthcare itself continues to evolve.
And there is some embedded elitism in all I have written about here. Another topic, another essay.
Thank you for your comments here and in your brief article "Therapy That Isn't Psychotherapy." It provided clarity regarding dynamics I had sensed but was unable to properly name. I think there is a distinction between honing the skills necessary to be a sound, credible therapist for a person seeking help and therapeutic culture, which places heavy emphasis on what the zeitgeist demands and sells as mental health. Of course, I recognize there is more to it than this simple bifurcation, but it provides some basis, at least for me, to get my bearings. Practically, this means I will pursue additional therapeutic training as my graduate education / curriculum was marked by considerable redundancy (e.g., a steady diet of trauma, "evidence-based" treatments and soup de jure modalities). Dr. Shedler's posts help too!
I agree with you, and I've written about my concerns about this "real" or "not real" psychotherapy. One would have to watch "most therapists" to make such a claim, or at least cite one piece of evidence.
I’m a trainee in the UK.
When looking at training schools, not a single one appeared to be training people in this ‘lay person’ helping style.
Perhaps there is another level of psychotherapy training I’m not aware of. I’d be surprised if a therapist with this working model would be accepted as a member of the UKCP (the governing body my college belongs to).
I also agree with the comments about this posts sweeping statement and generalisations.
Perhaps more specificity would be useful.
I know you’ve made posts about what a bad therapist is, and also a good therapist. But it’s common for Substack posts to live in isolation.
I am not in a position to speak to training in the U.K. But one thing I do know is that programs that offer poor training all represent themselves as offering the highest quality training—especially to prospective applicants.
What a great conversation! Thanks to all for taking the time.
I’m still stunned by the fact that many of my peers during training had not had any psychotherapy themselves, nor was it insisted upon by the (prestigious) university. I’ve learned as much from the two excellent psychotherapists who’ve treated me over the last 20 years as I did /do from years of training and ongoing supervision.
🎯 I’ve been stunned by it for decades.
I believe this is in part about engaging in the art of confrontation in a manner that is empathetic and being able to sustain the process of building a relationship despite the challenges.
Can you give an example of a " real psychotherapy " intervention vs a lay helper one, otherwise this feels vague. Thank you!
Sure. Check out this Substack essay.
https://jonathanshedler.substack.com/p/the-relationship-is-the-treatment?r=5tjn6h
I can’t give this a proper answer, but if you read back through Jonathan’s Substack articles (most are quick reads) I think you will get a better feel for what he means here.
In my own words, a lot of therapists provide “validation therapy” and their clients begin to feel better and move on. But real therapy involves examining patterns of relating and becoming aware of your own mal adaptive patterns. This awareness opens the door to choosing healthier ways of showing up in relationships.
Well said. And yes, I have addressed this in other posts.
Beautifully stated. I call this "therapy that isn't psychotherapy":
https://www.psychiatryonline.org/doi/full/10.1176/appi.pn.2025.06.6.12
🙏 I fear “therapy that isn’t therapy” is increasingly the norm
A colleague called this "How-Ya-Doin'" therapy. Unfortunately it is rampant. This fact is a statement about the power of the inner minds of both participants to hold onto what is comfortable. I agree with Erika, below. The real discussion is about what constitutes "real therapy." Ultimately, it has to be measured by the results.
Great piece - thank you. The increased use of AI as therapy and companionship can make our work as therapists most challenging. AI offers constant "validation"; while psychotherapy requires friction (within a safe container). The therapist must be comfortable with discomfort, both that of the client, and the one in themselves when challenging moments arise.
My most import mentor once gave me an unforgettable zinger. It was intended to sting such that I wouldn't forget it. "If you would stop trying to be so damn helpful maybe you could finally freaking help somebody" [leaves room].
Nice. Thought this paired well with the last article, about moral education. I always thought the moral-educators-as-“therapists” were implicitly accepting that they’re unable or unwilling to engage in real psychotherapy, so they’re instead telling people what to think or telling people they’re right or wrong for thinking the way they do. As if that’s an acceptable alternative to meaningful psychotherapy. Really gets my goat.
I think it may be easy for the therapist to feel rewarded in making other’’ feel good, and they end up doing cycles of “feel-good” sessions week after week. In reality, this is the antithesis to the beginning of growth/healing one’s psychological struggles.
I find your thoughts on some modern therapy and therapists interesting. This could be a good panel or dialogue discussion as part of a didactic conversation among professionals, let me know if you’d be interested in collaborating. I am a limited, licensed psychologist practicing in Michigan, I trained in a psychoanalytic psychodynamic program and have been a psychoanalytic patient for almost 20 years, the way I practice includes that, but is not in any way traditional psychoanalysis or psychodynamic, I’m interested in your thoughts about the rise of quasi therapy and quasi therapist on social media, it would be an interesting discussion.
I agree with you on many points, particularly when in the wild West of Instagram and TikTok there are non-licensed untrained people positioning themselves as experts are professionals, however, I also wonder if it’s a scenario where the genie is out of the bottle, visa V social media, and if there are benefits to this sort of thing, normalizing, deep path, authorizing, and in some way, inviting younger people into a space in which they may pursue whatever type of therapy genuinely becomes helpful for them.
Anyway, could be a long and interesting conversation, I don’t know if you have a podcast, but if you do, I will give it a listen. 🙏
I love that this is being brought up! I agree that there is a fundamental, relational element being left out of a lot of training on how to be a therapist.
AND
I can imagine if I read this, as someone who was so passionate about their work as a therapist and had trained hard and done exactly what they had been taught, and then I read that I’m missing something vital to doing “real” therapy?
That’s scary.
My defenses go up.
It’s hard to take in any information when I’m in that mode.
This makes me wonder how often we mistake comfort for change. Therapy that feels good in the moment is not always the therapy that transforms patterns.
As a new AMFT, this resonates. My graduate program did a good job offering a buffet of modalities — which is something I appreciated — but now that I am seeing clients, I feel myself having conflicting impulses about what I want to do in the room. I want more training.
But my understanding is that psychodynamic treatment outcomes aren’t significantly
different than other types of therapy? There could be pitfalls with a mishmash / DIY approach (that’s what I’m currently experiencing), but could one be trained in CBT or somatic work and still help people? Is psychodynamic the only or best way? Maybe you’re articulating a different concern.
On a side note, I’ve recently discovered your work on YouTube and this Substack. I find it helpful as I try to make my way here. Thanks for sharing your perspective with the public. I genuinely appreciate it and find it helpful.
Dr Shedler has a seminal paper that addresses this exactly. Please see https://jonathanshedler.com/PDFs/Shedler%20(2010)%20Efficacy%20of%20Psychodynamic%20Psychotherapy.pdf
Thanks! Really appreciate you posting this.
Great, as always. Thanks for posting!
This is a strong claim. I’m curious what evidence you’re drawing on when you say “most therapists” remain in the lay helper phase. Are you referencing outcome research, supervision studies, or training data?
Given the scope of the statement, I’d genuinely be interested in seeing the empirical grounding behind the conclusion that meaningful psychotherapy is increasingly rare.
Yes to this. I realize research can't explain everything and has its limits, but sweeping statement without proof feel very dangerous to me. Opinions matter, but there is danger in framing opinion as fact....