THE SHRINKING OF AMERICA: Myths of Psychological Change

Block-out the title, ignore the exaggeration, disregard the contentiousness and repetition, and this reduces to a single, plain, reasonable statement in the appendix: ""human beings and relationships are difficult to change and typically the alterations made are modest."" To arrive at Ms ""main message,"" however, therapist Zilbergeld (Male Sexuality) mounts a broadside attack on the ""therapeutic sensibility,"" without the insight-fulness of Philip Rieff or Christopher Lasch, and also indiscriminately assails the range of psychotlierapies, from psychoanalysis to the latest quick-fix. The result of this overkill is to belittle the therapeutic outlook and cast doubt on the reality of emotional disturbance--a dubious service to the intended popular audience. In a typical clever-but-facile ploy, Zilbergeld twits the American Psychological Association career guide, which unsurprisingly suggests that psychologists explore myriad ""social problem areas."" (Then he parallels the radical criticism of Lasch and the reactionary criticism of Thomas Szasz.) Centrally, Zilbergeld undertakes to demolish the so-called therapeutic myths. Yes, most clients receive some benefit from treatment. But: 1) for most problems, ""you can expect about the same results regardless of which therapy you choose"" (except that behavior therapy excels for simple phobias, sexual problems, and some compulsions; and family therapy tops individual therapy for marital strains); 2) some problems--""the less serious, less persistent""--are much more amenable to treatment than others (among the resistant, or hopeless, Zilbergeld classes depression, food-, drug- and tobacco-addiction, schizophrenia, and socially-deviant behavior); 3) the most common benefit of therapy is not behavior change but ""caring, comforting, and structuring"" (i.e., people feel better); 4) most change is modest, not dramatic; 5) lengthy therapy does not produce better results; 6) most changes do not persist over time (though, for suspicious reasons, studies are scant); 7) therapy, far from being ""harmless, at worst,"" tan produce negative changes (guilt, for one--though Zilbergeld leans heavily on client-therapist sexual relations); 8) ""therapy begets more therapy""; 9) and, perhaps most controversially, professional therapists are no more effective than other caring professionals (teachers, ministers), understanding relatives or friends, or even oneself Zilbergeld concludes that we've been bamboozled by the push-for-change and the idea that it's easy; and he advises, as have others, that we accept many problems as ""inescapable limits and predicaments of lire."" Though the criticisms are not new, they are more responsibly put than in Martin Gross' testy The Psychological Society (1980). But there is danger, still, in the oversimplification and overstatement.