How Sad Do You Feel Right Now?

Therapists are lurking everywhere. That’s the warning Abigail Shrier offers in her new book Bad Therapy: Why the Kids Aren’t Growing Up. You might have spotted a few of the therapists or pseudo-therapists who have infiltrated your own life. It’s the friend solemnly asking whether your headache is happening around the time of a painful anniversary, because, as you both know, the body keeps the score. It’s the boss asking everyone to begin the meeting with an emotional check-in, and the co-workers chiming in with “I feel a tightness at the base of my ribs, it feels anxious but also yearning.” It’s the school counselor asking your daughter if anything is troubling her and clearly expecting a “yes.”

Shrier is a therapy skeptic. Partly this is because as therapy has become common, depression and anxiety have become more, not less, common too. But a key part of her objection is the way therapy has become more commonly offered to children. Kids seldom make the choice on their own to seek treatment, so their access to therapy is governed by how troubled adults judge them to be. Shrier suspects that adults are too eager to discover problems that they think they can solve for children, and, in doing so, to take on the role of heroes.

As Shrier frames it, an invitation for a child to begin therapy comes with a double message: “Your mother thinks there is something wrong with you” and “Your problem is above her paygrade.” Sometimes, of course, that is true. Parents can’t simply nurture their children through schizophrenia or anorexia, though they can try to reduce exposure to risk factors like marijuana and ballet. But Shrier’s perspective is informed (and sometimes limited) by her experience researching and taking flak for her first book, Irreversible Damage, which explored the sharp, sudden rise in gender dysphoria and transition among teenage girls and the eclipsing of parental judgment by a new field of experts.

Her new book is sometimes pitched too directly to the parent-versus-school culture warriors, and it’s hard to avoid noticing that she relishes finding a particularly stupid opponent to expose. But at the heart of her critique of therapy is a necessary, fascinating question about whom we trust to treat us. Therapy began as a skilled, quasi-priestly role. What are the risks of its democratization, now that therapy is everywhere?

Therapeutic practice awkwardly straddles a professional–amateur divide. It retains a halo of seriousness because it’s practiced by real doctors, although its origins and foundational theory come long before the days of clinical trials and modern medical standards. And in the present day, little bits of therapeutic practice are pared off from their discipline, remixed with a soupçon of wellness culture, and dispensed by just about anyone. It’s not entirely a surprise — after all, some randomized trials have found that doctors can do as much good, or more, prescribing a cognitive behavioral therapy workbook as antidepressant pills. It makes sense that someone who has received a real benefit from self-guided therapeutic work might be eager to pass on fragments to friends.

Shrier correctly identifies one of the biggest problems with the democratization of therapy: the way it eliminates the privacy and set-apartness of a therapeutic relationship. Professional therapists are supposed to maintain clear boundaries with their patients. For the most part (pre-pandemic, at least) they see patients in a defined space, at a defined time, and usually remain reserved. Therapists are supposed to avoid “dual relationships.” If a therapist sees you, she isn’t supposed to also treat your mother, your husband, or maybe even your boss. The therapeutic relationship is supposed to be air-gapped, so the secrets you spill can’t influence or inform someone else’s treatment, or vice versa.

But with, say, a school counselor, dual relationships are a given. It is, in Shrier’s view, “an ethical compromise, which arguably corrupts its very heart.” The counselor talks to everyone and can wander through the lunchroom, leaving a kid to suddenly be on display to his quasi-doctor while hanging out with his friends. And, of course, a school counselor ultimately works for the school administration, serving its interests and not only those of the students or parents. At the college level, this could mean schools expelling students who seek help for depression, perhaps to preserve the image of people thriving under immense pressure, or in order to limit the liability incurred by suicides on school property. In high school, it might mean sharing normally privileged information with your teachers “for context.” In 2005, the American Counseling Association seemed to recognize the tension between the privacy of traditional therapy and the relative openness of school counseling, and revised its code of ethics to say that dual relationships were permitted, as long as they are non-sexual and not harmful to the client.

In a school environment, it’s still pretty clear who the counselors are, even if their conflicting loyalties aren’t explicitly acknowledged. But the broader expansion of therapy to non-professionals means it is common for therapeutic tools to be wielded by anyone, with no accompanying disclosure, guidelines, or code of ethics. The implication of therapy’s growing amateurization is that it is powerful but not obviously dangerous. It’s not so unlike the way that meditating and taking hallucinogens are increasingly regarded. There’s a certain level of respect for the way these experiences can alter the mind, but also a strong expectation that you can mess around on your own and avoid catastrophe. The risks of LSD and ayahuasca are relatively well known, but intense meditation also can trigger psychosis. Is a culture of therapy-speak the less-chemical equivalent of your friends microdosing the punch bowl?

Shrier essentially wants parents to be on guard against their kids being offered roll-your-own therapy, much as they might be (or might have once been) about marijuana. She sees therapy-for-the-masses as posing serious dangers, especially when administered by amateur therapists who can’t imagine any downside to examining one’s own thoughts closely.

The dangers of over-attentiveness aren’t unique to therapy. Whenever screening for an ailment becomes common, there’s the possibility of what are called “iatrogenic effects” — medical problems caused by exposure to doctors and their interventions. For example, the U.S. Preventive Services Task Force has been revising and re-revising mammogram guidelines, telling women to come in starting at forty years old, no, make that fifty, no, never mind, back to forty. Breast cancer advocacy groups push for broader, earlier, more urgently recommended screenings, focusing on the women saved by early detection. But the more low-likelihood women you invite to get screened, the more false positives you get. For some women, that means the anxiety of a follow-up mammogram, an unnecessary biopsy, or further treatment.

Similarly, asking children to turn inward and examine how they feel may filter some kids into more intensive counseling than they need. But Shrier is worried about another kind of danger that goes beyond false positives and unnecessary treatment. Some iatrogenic effects are more containable than others. A mammogram requires a visit to the doctor, but an “emotional check-in” is something teens can practice themselves, at any time. If there are downsides to self-managed therapy, they can be experienced much more frequently and intensely than something that requires a professional’s participation.

When Shrier signs up for a “wellness tracker” intended for teens age sixteen and up, the basic check-in offered by the app has a number of negatively flavored questions for the user to meditate on and rate on a scale:

“How worried do you feel right now?”

“How down do you feel right now?”

“How often do you feel left out?”

“How sad do you feel right now?”

After answering a battery of these kinds of prompts, a child who would have casually described himself or herself as happy may feel less content and more troubled. Casual, self-guided therapy asks the patient to be both subject and instrument. It’s easy for reflection to slide into rumination. As Yulia Chentsova Dutton, the head of the Culture and Emotions Lab at Georgetown University, tells Shrier, “We are basically telling [children] that this deeply imperfect signal is always valid, is always important to track, pay attention, and then use to guide your behavior, use it to guide how you act in a situation.”

For a child or an adult, repeatedly drawing one’s attention back to feelings of discomfort can create a negative feedback loop, over-sensitizing oneself to irritations that might have otherwise passed unnoticed. Getting bogged down in anxious self-examination can start to feel like making progress, amassing more and more information to pore over with a therapist or another therapeutically-minded friend. What might have been a brief, passing unhappiness or awkwardness is probed urgently for what wound or weakness it might reveal. These excavations work with the assumption that we are largely unknown to ourselves. Like an astronomer observing a black hole by tracking the subtle wobble of surrounding stars, doing the work means being alert to subtle signals of the hidden ordering of one’s internal universe.

The question of the extent to which our feelings are us is a complicated one, and not solely the province of psychologists. Shrier is focused on present-day excesses, but looking beyond therapeutic practice offers some alternatives to either excessive solicitude or toughing it out. Eastern Orthodoxy gives the name logismos to what a therapist might call an intrusive thought. In The Mountain of Silence, a monk on Mount Athos in Greece tells author Kyriacos C. Markides that “a logismos does not necessarily emanate from within [a person], but is directed toward them from the outside.” Reflecting on one’s thoughts is a process of judgment, not just self-discovery. Taking responsibility to judge our thoughts implies there are parts of ourselves that we prune, that we are aiming to grow in a particular direction. That’s easier for a monk to say than a therapist.

A therapist begins by asking the patient what his or her goals are for therapy. Although Shrier suspects many counselors of having hidden agendas, professional practice is framed neutrally. If parents are increasingly relying on professionals to guide them in shaping their children, it may be because the parents are not confident they have a normative vision of human life to pass on. The rise of parenting influencers who offer scripts for talking to your child is a response to parents who don’t want to raise their children as they themselves were raised, but don’t possess a positive vision of their own.

Ultimately, Shrier hopes that parents reading her book will be a little more confident in their own judgment and responsibility and a little more suspicious of the semi-trained, solicitous adults aiming to “fix” their children. Shrier sees part of parents’ task as expecting and instilling resiliency in their children. She worries that a therapeutic culture teaches children they are fragile and that damage persists without active work to undo it.

In my own life as a parent, I already practice some of what Shrier recommends. I don’t run toward my children when they fall, and I wait for them to tell me if they’re hurt, rather than coaching them into anticipating distress. But resiliency is always an intermediate good, a virtue I want them to have so that they can rush on in pursuit of higher virtues. Parents aren’t called to simply make their children strong, but also to make them sensitive to the right things — to beauty, to sorrow over evil, to wonder. Taking a step back from the present therapeutic culture requires parents and children to take up philosophy instead.