Book Review: The Therapy Industry, by Paul Moloney

I don’t have a lot of time or head space for reviews of any kind these days, however I try to make an exception for work which deserves attention, if only for sake of better exposure and discussion.

One of these works is the book The Therapy Industry, The Irresistible Rise of the Talking Cure and Why it Doesn’t Work by author Paul Moloney (Pluto Press). I came across this provocative title through Moloney’s recent curation of new book releases on the site New Left Project. What follows is a necessarily compressed review, certainly more so than what you would normally find for this sort of work, and perhaps more succinct than this book deserves.

Let’s stop the bus and draw your attention to the driver. My interest in this book is complex and certainly not unbiased: I’m a relational psychotherapist – it is a career I chose later in life and one whose practice and philosophy I have a deep, evolving respect for. However, increasingly I have found myself dissatisfied with the level of critical discussion about the array of available therapeutic modalities, the politics non-medical practitioners encounter with respect to recognition in an increasingly medicalized notion of mental health, and not least the pecking orders (particularly reinforced by those practitioners who receive provincial health care coverage, those who receive coverage via corporate health benefits plans, and those who receive neither).

I was drawn to this book not only for its stated critical approach but also, perhaps relievedly, that it was written by someone who is a counselling psychologist and lecturer. This is not, in other words, a journalistic view from the outside. Quite selfishly I thus figured that it must have some sort of a happy ending. And, in short, it does, though you need to swallow some hard medicine first.

The gist of The Therapy Industry is that there is a disconnect between the mainstream approach toward treating those with mental health issues and the realities of (at the very least Western) industrialized society which is becoming more and more demanding upon us, economically, socially, and – as a result – psychologically. The system generally available to the public – from awareness campaigns to the attitudes of medical and non-medical practitioners – goes to lengths to make those seeking help feel that the problems they are experiencing are the product of their genes or their own faulty reasoning about the world around them. Or, if the practitioner does recognize that there is a probable cause that is environmental rather than genetic, the prevailing course of treatment is, in essence, mind over matter. According to the book there is, in short, some denial about the more environmental causes in the marked rise of mental health-related issues over the last century. And worse still, if there is clinical – which is to say institutionalized – denial then that doubly disfavours those seeking help.

Moloney points out is that there is little research which points to the effectiveness of talk therapy for those seeking help – or rather, research which bears enough clear evidence to be empirically convincing of its merits (compared to, say, a patient seeking no professional help at all). And the reason for this is not a deficit of research studies – in fact, particularly in the case of CBT (cognitive behavioural therapy) there are hundreds of studies – but rather the near-impossibility of a more thorough (that is to say, persuasive) level of study, to the same standards as epidemiology for example, which looks at, among many things, long-term outcomes. There are therapies in place which wish to be seen as scientific yet which from a very basic perspective are impossible to validate scientifically. In current form, according to Moloney, most therapeutic research studies don’t pass muster. This is understandable: working with someone’s emotional or psychological concerns is by necessity subtle, fragile, and – to be effective – exceedingly individualized work. There may be standardized diagnoses (according to the DSM, currently in its Fifth edition), but these come from and exist in a jargonized medical infrastructure which aims to process patients with checklists rather than understand them as individuals. And if we live in a society increasingly demanding that we live and work under conditions that are less and less concerned with our long-term welfare then those we seek help from should ideally be a respite from this, shouldn’t they?

This is a book with a grand and socially relevant reach which this blog (and my time, unfortunately) cannot aim to encapsulate without another book being written (which reminds me of a similar insight by Russian filmmaker Sergei Eisenstein, who said that one can only truly critique a film by making a film in response). Where The Therapy Industry succeeds is by establishing a persuasive correlation between the identification of mental health issues (starting in the form of neurasthenia – the precursor of what we now commonly refer to as anxiety disorder) and the rise of the Industrial Revolution and the social consequences of having large portions of the public living in impoverishment and neglect – a trend which, with the rise and fall of the middle class, hasn’t abated. Moloney also does a great job slicing and dicing the expanding kingdom of CBT and its presumed superiority by poking holes in its much-vaunted research credentials. Along the way he also questions strict behaviourist approaches on their lack of humanist grounds and rubbishes the cult of “positive psychology” as nothing more than wishful thinking.

Where the book succeeds less is in its habit of heaping everything that is “talk therapy” into a single formless entity, something perhaps done out of necessity to make a wider point, but in doing so he neglects the reality that not all forms of therapy are equal in how they are able to recognize (or at least attune themselves to) the extent of the client’s socio-economic as well as familial/cultural circumstances. There are progressive, effective approaches which I would hate to see lumped in with, say, old-school Freudian psychoanalysis. Also, in at least two instances Moloney questions the medicalized notion of mental illness as a brain chemistry problem (and its troublesome relationship with pharmaceutical companies) and yet never seems to reserve space for an elaboration on this point (Is there then never a relationship between brain chemistry and mental health?). The Therapy Industry‘s provocative subtitle is The Irresistible Rise of the Talking Cure and Why it Doesn’t Work – this isn’t altogether true. In fact, it’s a little disingenuous. That 19th century cliché aside, talk therapy does not “cure” but it certainly does work, though I empathize with Moloney’s frustration at the lack of some standardized measurement to this effect. Perhaps the better question to ask is which type of therapy (or therapist) for which type of individual, for which type of concern is most effective? To be fair, throughout the book, Moloney hints at approaches which have more efficacy and positives are scored in the book’s last chapter. In short, the promising reach of the book’s mandate doesn’t seem to totally materialize.

Nonetheless, this is a conversation starter. A necessary conversation, in my opinion. There are some great insights here for those of us who believe in the effectiveness of talk therapy and, perhaps for good reason, some insights which will start many a debate. It is unfortunate that it was released with little notice in 2013.

Paul Moloney’s The Therapy Industry, The Irresistible Rise of the Talking Cure and Why it Doesn’t Work (ISBN: 9780745329864) is available in specialized bookstores (locally, try Caversham Booksellers) or online.