Psychotherapy is today one of the largest helping professions in the West. The American Psychological Association (APA) counts more than 172,000 members, and the US government counts 204,300 psychologists, 483,500 mental health counselors, and 77,800 marriage and family therapists at work. The share of adults who saw a mental health professional in the past year more than doubled since the beginning of the century, from 10% in 2001 to 24% today. One recent study put the number of adults in outpatient talk therapy at nearly 22 million a year, up from about 16.5 million only three years earlier. In 2012, the American Psychological Association declared psychotherapy “effective and highly cost-effective.”
And yet psychological problems and psychiatric disorders keep rising. Depression among Americans aged 12 and older rose 60 percent over the last decade, from 8.2 percent in 2013 and 2014 to 13.1 percent in 2021 to 2023. The share of adults ever diagnosed with depression is today an astonishing 30%, almost ten points above its 2015 reading.
A 2016 study in Pediatrics tracked the share of adolescents reporting a major depressive episode rising from 8.7 percent in 2005 to 11.3 percent in 2014. A 2024 study of 1.7 million young people found clinical depression up about 60 percent and anxiety up 31 percent in only four years.
“Endless psychotherapy is a waste of time and money at best, and harmful at worst,” writes psychotherapist Jonathan Alpert in a new book, Therapy Nation. I spoke to Alpert last week, and our conversation follows the video above.
Of course, mental distress was rising before the creation of psychotherapy, and psychotherapy can produce real benefits, particularly for specific conditions. In the late 19th Century, a neurologist chronicled an epidemic of nervous collapse he named neurasthenia, marked by fatigue, anxiety, and depressed mood in an 1881 book. The French neurologist Jean-Martin Charcot reported that anxious neurasthenics made up the bulk of his own private practice. And a skilled therapist can ease a particular patient’s anxiety and even lift an episode of depression. Millions of people say, and have shown, that psychotherapy has helped them.
But the fact remains that psychotherapy grew in popularity over the same periods of time that people have reported worsening mental health. This is true not just over the last 120 years but also over the last 20 to 35 years. The rate of depression among adults under 30 more than doubled, from 13% in 2017 to 28% in 2026. Anxiety disorders among people aged 10 to 24 rose 52 percent globally between 1990 and 2021. If psychotherapy is, as APA says, “effective,” it’s either, at best, not effective enough or, at worst, contributing to the problem.
And there is evidence that psychotherapy often makes things worse. A 2006 study of 1,868 individuals found that people who received less psychotherapy achieved greater “reliable and clinically significant improvement” than those who received more. While this could simply represent the reality that people with worse mental distress require less counseling than those who do, it could also mean that psychotherapy worsens mental health.
Through the 1980s and 1990s, recovered memory therapy persuaded thousands of patients, often young women, that they had survived childhood sexual abuse that never happened, resulting in false accusations. A Houston jury awarded one woman nearly $5.8 million in 1997 after therapists implanted false memories. By one estimate, more than 50,000 American therapists accepted the theory of repressed memory uncritically.
And large studies challenge the credibility of the entire field of psychotherapy. A 2018 review estimated that 5 to 20 percent of psychotherapy patients suffer adverse events, including new or worsening symptoms. A 2024 reanalysis of youth depression trials concluded that about one in five young patients got worse during active treatment. Across studies, 40 to 60 percent of psychotherapy patients never reach recovery.
What went wrong? Why has therapy failed to deliver on its promise? And why does it so often cause harm?...
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