Psychotherapy as religion: the civil divine in America

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This cleverly argued, craftily worded polemic makes for provocative, albeit heavy and repetitive reading. The author_s thesis is that psychotherapy, including behavioral treatment, has no evidence of efficacy and survives only because it serves as a civil religion embodying the ill-advised American values of personal responsibility and self-help. It has only a nonspecific placebo effect, precipitating improvement that patients would eventually have made without psychotherapy. Furthermore, it is not only ineffective (specifically) but also actually harmful. It makes patients dependent on the therapist. Worse, by deluding patients into thinking that they can help themselves, it induces unwarranted guilt when they fail. Worst of all, by claiming to provide a relatively easy, cheap remedy for depression, anxiety, and other mental illnesses, it excuses society from the need to reallocate resources to alleviate the socioeconomic inequities that Epstein implies cause mental illnesses, or at least those that are treated with psychotherapy broadly defined. Obviously, his message is as much political manifesto as science. Therefore, to review the scientific issues raised, which could be of some use in advancing the scientific base of psychotherapy, we must first separate them from the political message by clarifying his political agenda and placing the whole issue in historical context. Thus, the first part of this critique deals with politics and the second part with valid and invalid criticisms of psychotherapy_s evidence base.