Faceless Therapy

Recently, I read a tweet by health reporter Andre Picard saying “You don’t need a therapist to get effective therapy” and linking to a New York Times article about the website Mood Gym, an interactive Cognitive Behavioural Therapy (CBT) program for depressed individuals.  Picard retweeted, apparently without critical examination, the dubious conclusion that, since health insurance will not cover face-to-face therapy for someone without a diagnosable disorder, “there is a clear need for the online version”.

Say what?  

Isn’t an “online version” of “face-to-face” an oxymoron, Mr. Picard?
Right after this a client came into my office with a prescription from her doctor for CBT to treat “depression and anxiety”.  The client is a young mother from another country whose friends and extended family are thousands of miles away and whose children go to school in a foreign language.  Although she has two university diplomas, after her second maternity leave she had to enroll in University classes to qualify for a job in an area for which she was not previously trained, then for financial reasons accepted a very stressful office job where the boss’s management style would fit anyone’s definition of “toxic”.  After a year of this, she started to despair; hence the visit to the doctor. 

The woman told me she was surprised that, after just ten minutes in consultation with a resident in her twenties, she was walking away with a medical diagnosis, drug prescription and referral for CBT.  I listened to her outrage at the label and the doctor’s swift pathologizing of her normal reaction to an abnormally stressful situation.  We laughed about the young doctor diagnosing her as having an adaptive disorder as opposed to her having a life that was hard to adapt to.

Are Picard and other health reporters touting their shallow nonsense to promote “mental health” or to get rid of talk therapy?  One has to wonder.  Mood Gym, the “online version” of CBT under discussion, has been shown to be no better than other informational websites at preventing depression whereas face-to-face therapy and a therapeutic alliance with the right therapist has been proven over and over again to be unsurpassed in its curative effect on all kinds of diagnoses.  Picard has retweeted other “studies” purporting to show the uselessness of non-medical approaches to psychotherapy without apparently studying them or responding to those who do

There seems to be an eagerness to do away with the human face of interaction, a strange desire to reduce the complexity of being human to the zeroes and ones of binary coding.  Take the famous Harlow experiments on rhesus monkeys.  Behaviorists challenging the importance of maternal presence for child development were sorry to learn that monkeys well know the difference between wire surrogates and a flesh and blood mother, that they prefer love to food, and that maternal care, far from “spoiling” our offspring, enables them to thrive mentally and physically.  He also proved that depression in animals was clearly linked to social isolation in his famous if controversial studies of the pit of despair.
Successful psychotherapy can integrate many techniques and ways of working with people, including CBT, but it is always, first about rekindling the warmth of human connection in people who need that warmth. It is human, personal and real.

Jesus asked: “What father among you, if his son asks for a fish, will give him a serpent instead?” Maybe no such fathers could be found then, but there are now “health experts” among us who, when asked for therapy, would apparently send their depressed sons to their computers.

(When my client left today, she was visibly relieved; maybe not cured, but definitely showing signs of feeling better)

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