Therapy has become less like medicine and more like a lifestyle purchase.
Most of what's being promoted in the culture now as therapy is insta-therapy.
Today's Propy Plus deep dive is on therapy: what it does, what it doesn't do, and who's selling it. In December, I wrote a No Mercy, No Malice post called "The Cult of Therapy." My argument was the following: therapy has become less like medicine and more like a lifestyle purchase, the emotional equivalent of a Birkin bag. I got real pushback, some of it even civil. Therapists wrote rebuttals, Psychology Today ran a response, the comment section on my own site turned into a genuine debate. Fair enough, I think that's actually probably a productive exercise. But the data still points in the direction of therapy having become an expensive band-aid for a larger problem, and that problem is economic. In America, the poorer you are, the more likely you are to be mentally ill. Below the poverty line, it's 29% of adults; at twice the poverty line and above, it drops to 21%.
And there was an even more interesting piece of data in the post that I think is worth revisiting. A 2022 study of mental health videos on TikTok found 83% were misleading, and only 9% came from creators with any relevant professional qualification. A newer study focused this year, published in PLOS One, focused specifically on ADHD content, found something even starker. Researchers had licensed psychologists review the top 100 TikTok videos under #ADHD. Nearly half a billion combined views. Only 49% of the claims checked out. Just 20% of the creators shared any credentials, and none were licensed psychologists, psychiatrists, or doctors. More than half had financial incentive, as in they were selling something tied to the video.
So we have two different things wearing the same name. There's therapy, which happens in a room between two people, usually one who is licensed, and there's therapy, the content genre: self-diagnosis, boundaries, attachment styles, trauma, delivered in 30 seconds to 3 minutes by someone with a ring light, no license, and often a product to sell you. Of course, none of this is to say that therapy can't be and isn't useful. It is, especially for the 23% of American adults who experience mental illness. I said in the original piece, and I'll say it again here: the problem isn't therapy. It's the marketing of therapy as a prerequisite for a decent life, and the 30-second version of it that's replaced the real thing in most people's feeds.
And when you look at real therapy, meaning actual clinicians, actual patients, the evidence is stronger than people assume. One of the most consistent findings in psychotherapy research isn't about which technique works; it's about the relationship itself. What researchers call the therapeutic alliance: trust, a shared understanding of the goal, a real human bond. That's the variable that predicts outcomes more reliably, which tracks. A relationship is exactly the thing a TikTok video can't offer you, no matter how accurate the caption is.
Which brings us to our guest. Dr. Jonathan Shedler is a clinical psychologist and researcher whose work has spent two decades making the case for what real psychotherapy actually is and does. And he too has been critical of what's replaced it online. He doesn't think the content is therapy either. So, what is therapy, and which parts of it are overrated? Let's ask Dr. Jonathan Shedler.
Jonathan, thanks for joining us.
So, we wrote a piece arguing therapy has been oversold as a cultural cure-all. Where do you think we got that right, and where did we get it wrong?
Good question. You got some right and some wrong. Things are being way, way, way oversold. 100% right about that. Most of what's being oversold has very, very little to do with what I would consider to be legitimate psychotherapy. So I'd like to make a distinction between therapy culture on the one hand, which really comes from pop culture and internet influencer culture, and legitimate psychotherapy. Most of what's being promoted in the culture now as therapy is, you know, really, you know, social media, internet, pop, you know, insta.
Yeah. My sense is that there's a lot, there's now an incentive system or an ecosystem to watch, let me give you advice about therapy with a ring light, or what passes as therapy. And that the cloud cover that is a general gestalt or argument that especially among young men, that all young men, before they get a job, before they engage in a relationship, or quite frankly they do anything, they need to work on themselves with therapy.
And my sense is, and I've said this, that I think a lot of the anxiety and a lot of the struggles young men are facing is a natural part of the economic struggles of a young man. And that the greatest therapy bomb would be a detonation of more jobs and more venues for people to establish relationships. And that therapy has been kind of sold as a cure-all. While it can play a hugely important role, I'm not against therapy. It's been sold as a, like I said, a one-size-fits-all that everyone, especially young men, need to work on themselves.
Yeah, I actually largely agree with you, but I'd like to sharpen some of the points and some of the assumptions beneath that. You know, "everyone should get therapy" is just a meaningless statement. There's no such thing as therapy. There's therapy to solve a particular problem, a psychological problem at a particular time for a particular purpose. There's no generic thing called therapy, and there's no, you know, generic idea of working on yourself in some kind of, you know, nebulous, unspecified way. Real psychotherapy has a purpose. And this is not coming from legitimate psychotherapists. This is coming from online influencers and pop culture: everyone should go to therapy to work on themselves in some unspecified way. And that's not how you start therapy. That's not what real psychotherapy is about.
So yeah, I agree. And I've heard you say, for example, one of the best things that you can do for your mental health, for men or for anyone really, is to have connections, to be involved in the world with other people, to make relationships. And it's really good advice. The people who need therapy can't benefit from, can't take that advice.
What happens when somebody knows and understands they would be much better off if they had social engagement with other people, and something inside them, something about their personal psychology, gets in the way of that? So they can get, you know, the best advice in the world, and they either can't take it in or they can't act on it because of internal conflicts or inhibitions or internal limitations, you know, that affect how they relate to other people. So the advice is good, but for one reason or another that is psychological in nature, that person can't act on the advice. That's when we start talking about therapy. And it's not working on yourself. It's: you'd like to have better relationships with people. Something is getting in the way of that. Something about you is getting in the way of that. Let's see if we could understand what that's about and work to change that so that you can follow great advice.
Yeah, I like that a lot, and I want to double-click on it because a lot of young men and women listen to this program, and I think that a lot of them would benefit from therapy, and a lot of them are being sold a bill of goods. And this notion that therapy is the base of all productive young adulthood or a pillar, which I don't believe is true.
But I look back to what you said. Okay, assume relationships are key, and if something's getting in the way of those relationships, you may want to think about therapy. The problem I would have had as a young person was being thoughtful and self-aware enough to know that something was getting in the way of my relationships. Can you be a little bit more specific in terms of litmus tests or signals or signs that a young person can recognize that help them distinguish or discern or recognize when they would be a really good candidate for therapy?
Yeah. Often people, I mean, there's an infinite number of answers to that question, but let me home in on, you know, on something straightforward. You have an idea of what you want to do. There aren't external obstacles that, you know, prevent that from happening. You'd like to do it, and either something inside of you stops you from acting on it. Maybe you don't fully understand what that something is, but, you know, it's like each time you try to do it, something inside of you is working at cross purposes with the rest of you, you know, or, you know, you try to do it, you try to engage with people, you try to, you know, create connections, and something keeps going wrong. And when something goes wrong, you know, once or twice or three times, you say, you know, well, bad luck, wrong person, didn't fit. When the same sorts of things keep going wrong over and over again, it's kind of a pattern, and you don't understand why it's happening, but you can see that it's a pattern.
Then we start asking the question: well, is there something that you're doing in relationships? Is there something about, you know, how you see yourself or how you see the other person in a relationship? The relational patterns that we all play out all the time with everyone. Is there something about our relational patterns that's getting in the way? When things like that are on the table, then we might start thinking about therapy. And once again, it's not generic therapy, "I'm going to work on myself." It's: you meet with the therapist, you spend a lot of time getting to understand this person's life as an individual and this person's interior world as an individual, and you home in together on some understanding about, you know, something about the person that leads them to trip over their own feet or that gets in their own way, and that becomes the focus of psychotherapy. So it's not generic psychotherapy to work on yourself. Now it becomes: can I understand and change what keeps getting in the way of having more meaningful connections with other people? And that's a starting point for doing meaningful work.
