Depressed? Anxious? Maybe you should see someone. If so, good luck. According to the American Psychological Association, most mental health professionals are consistently and fully booked. Yet, for all that therapy, better mental health eludes Americans, says Jonathan Alpert, author of Therapy Nation—How America Got Hooked on Therapy and Why It's Left Us More Anxious and Divided. If anything, the author contends, mental health care is a likely cause of our collective psychological malaise.
Alpert, a psychotherapist who practices in New York City and Washington, D.C., alleges that a sizable swath of the profession—not all therapists of course—have failed their patients. They medicalize normal human distress, turn painful life experiences into traumas, and effectively blackmail patients into prolonging their stay in therapy lest they unravel without it. And they validate, validate, validate, reinforcing "dysfunction, self-absorption, and the quiet decline of resilience across America."
It's not that Alpert, a licensed counselor and performance coach, is a thoroughgoing therapy skeptic. He does believe in the transformative potential of clinical attention. Good therapy, he writes, helps patients "confront reality, tolerate difficult emotions, take responsibility, and build resilience in the face of adversity ... and has the power to help individuals and, by extension, strengthen the nation." It should be "clear-eyed, structured, and focused on results." Too often, however, it is not.
This stance has earned the author some detractors. Upon questioning aspects of therapy in a 2012 opinion piece ("In Therapy Forever? Enough Already"), his colleagues denounced him, ousted him from a professional networking group, and a commencement speaker at his departmental graduation ceremony repudiated him. Yet, as Alpert came to learn, lots of patients brought in a clipping of his essay to confront their own therapists.
Presumably, vindication came from patients who were spinning their wheels in therapy, "stuck in repetitive cycles of venting and stagnation," as the author describes them. Or the ones who realized that their too-lenient therapist allowed them to wallow, week after week, in an orgy of blame (their parents, their boss, their spouse).
Compounding these baseline problems is our current moment. Mounting political divisiveness, social disconnection, and ideological purity disrupt relationships in both intimate settings and the workplace, making them fodder for therapy. Fair enough, but, as the author asks, what happens when the therapist reflexively takes the patient's side in conflicts without exploring the complexities and the patient’s contributions to the friction? "Comfort is not growth," he insists.
What's more, a new strain of perversion—woke therapy—took hold after the murder of George Floyd and the October 7 massacre in Israel. Widely taught in schools of counselor education, as the author describes in heart-sinking detail, it is a practice that views people not as individual actors but rather as representatives of particular marginalized groups. Therapists often regard themselves as activists and impart to patients the importance of social resistance.
Woke therapy undermines virtually every tenet of psychotherapy: If a patient is white, the counselor's job is to help them see how they unwittingly perpetuate white supremacy. If black, the task is to sensitize the patient to how his race incited others to cause him distress, regardless of what brought him to therapy. Introspection is out. Externalization is in.
Therapy Nation is well-paced and sprinkled with clinical vignettes from the author's own practice. Over the course of the book, however, the author's caveats can seem redundant. In addition, I wish he tried harder to prove his thesis. For example, could people be flocking to therapy in high numbers because so many are unhappy? Perhaps that dynamic better explains the paradox of more treatment-less mental health than the notion that therapy itself is making us sicker. Or maybe there are limits to therapy when patients' social circumstances are so trying, or because they do not even have a mental illness in the first place. These are not mutually exclusive forces, of course.
The book's most striking shortcoming, however, is its ahistorical approach. Readers would never know that the therapy culture has been under scrutiny for over half a century at least. There is no mention of, for example, Philip Rieff's pioneering book, The Triumph of the Therapeutic: Uses of Faith after Freud (1966), in which the sociologist argues that Freudian psychoanalysis has replaced communal religion as the primary cultural authority, creating a "therapeutic culture" where the self—its desires and expression—takes primacy. Likewise, historian Christopher Lasch, in his 1979 The Culture of Narcissism: American Life in an Age of Diminishing Expectations, lamented that modern therapy encourages interminable self-scrutiny rather than active engagement with society.
In the late 1980s and '90s, Allan Bloom, Wendy Kaminer, and Charles Sykes identified the corrupting influence of moral relativism and victimhood on individual growth, self-reliance, and personal responsibility. Somehow the author presents a chapter on "the cult of trauma" without mentioning the two most influential "cult" leaders: psychiatrist Bessel van der Kolk and physician Gabor Maté. His discussion of medicalizing normal variants of emotional distress omits psychiatrist Allen Frances (Saving Normal, 2013). Finally, Coddling of the American Mind (Greg Lukianoff and Jonathan Haidt, 2018) and Bad Therapy (Abigail Shrier, 2024) have all put forth versions of Alpert's claims but are never acknowledged.
Finally, my feathers were seriously ruffled by his glib discussion of filmmaker Woody Allen (Without Feathers, 1975). "Allen has become the ultimate poster child for psychoanalysis gone wrong—proof that the longer one stays in therapy, particularly psychoanalysis, the more self-absorbed and neurotic they are likely to become," the author writes. Reality check: Allen, "neurotic" as he may or may not be, is a complicated, controversial man who has made great films that have become cultural touchstones.
For some patients, it is true, analysis may be too preoccupied with the past, too interior, and not action-oriented enough. But for others, the intellectual exploration afforded by analysis has been a great source of psychic freedom and a facilitator of growth and change. I should point out, too, that there are effective psychodynamically oriented treatments that fall somewhere between open-ended psychoanalysis and the time-limited, prescriptive version of care, called cognitive behavioral therapy, CBT, that the author clearly favors.
Extremely well-studied, CBT is a goal-defined therapy that helps patients identify and reframe negative thought patterns, such as false assumptions and misattributions. In a classic CBT-type intervention, the therapist might walk an avoidant or phobic patient through gradual exposure to anxiety-provoking situations, eventually neutralizing the fear.
Therapy Nation fits squarely in the self-help genre. It is full of practical advice, such as how to vet a therapist. A sample: "Be cautious of therapists who overuse terms like safe space, explore your feelings, or support you on your journey without mentioning actionable steps toward progress."
The author also points to ways that patients undermine themselves: Among these are the tendency to expect too much improvement, too fast, to withhold information, or become too invested in a self-diagnosis they made on TikTok. He advises patients, after being in therapy for many months or years, to ask themselves the following: "Do you feel increasingly self-reliant?" "Are you noticing tangible changes outside of the therapy office?" "Are you working toward your objectives?"
Therapy Nation makes a persuasive case that there is a lot of bad therapy out there—indulgent, regressive, and unaccountable—and that patients should be more demanding when they don't see progress. But whether therapy is dividing us or "accelerating societal decline," as the author claims, I am not sure. Still, fair to say, there are too many patients putting their trust in undeserving therapists. This book could be an antidote to their complacency.
Therapy Nation—How America Got Hooked on Therapy and Why It's Left Us More Anxious and Divided
by Jonathan Alpert
Hanover Square Press, 320 pp., $32
Sally Satel is a psychiatrist, senior fellow at the American Enterprise Institute, and coauthor, with Christina Hoff Sommers of One Nation Under Therapy—How the Helping Culture is Eroding Self-Reliance (St. Martin's, 2005).
