Nancy McWilliams against the “industrialization” of mental health care
In this video, psychologist Nancy McWilliams critiques how psychotherapy has been framed in much of popular culture, what she describes as “the commodification of therapy.” She discusses the idea that therapists are not “technicians” applying modalities, but that what matters is our ability to enter into meaningful relationships with complex human beings in a process of change. “We have to keep a sensibility alive that involves respect for individual subjectivity, individual suffering, the complexity of things, [and] the humility involved in approaching things as if we don’t know the answer.”
While simple solutions are great when they work, most people don’t need therapy to arrive at those decisions. In the face of complex problems, psychodynamic therapy engages us in a process of radical candor, in which we gain awareness of unconscious motives and increase our capacity to think about what is difficult and know what is painful. Some might call this insight, or when it’s more about being able to feel, increased emotional experiencing/tolerance of emotion.
I like to think of McWilliams’ work alongside the work of lawyer, writer, and activist Dean Spade, who has called for “radical discernment” about the solutions being presented in social movement organizing. In both situations, there is an interest in questioning the ways in which the frame for understanding how change happens is being set, and wondering if that is sufficient to achieve real, meaningful transformation. When change seems impossible—sometimes this is because we’re not asking questions about structure and framing, not because we’re asking for too much.
How long does therapy take?
I was delighted to run across this video of Jonathan Shedler discussing the question, “How long does therapy take?” In the video, he compares the therapy process to learning a meaningful skill like a language. What a useful metaphor! You might just need a few phrases to navigate an unfamiliar terrain, which you can learn fairly quickly. Short bouts of therapy can be helpful, even an app can make a big difference in a pinch. And at the same time, if you want to engage in a process that significantly changes your life—that allows you to travel to new places, to express and understand yourself and other people in new ways—just like the slow process of learning a new language, it will take some time.
In the second part of the video, Shedler also brings in a really useful critique of the current structure of much counselling research and training processes, which are infused with a bias towards brevity and small, immediately measurable impacts.
If you’re a therapy research nerd like me, you might be familiar with Shedler’s research. He critiques manualized “evidence-based therapies” as the sole standard of exceptional therapy in his classic 2010 article on “The Efficacy of Psychodynamic Psychotherapy.” The article summarizes research that finds that no matter what kind of treatment therapists say or think they’re doing, utilizing core psychodynamic practices within the therapy is predictive of better client outcomes.
And if you need any further reasons not to use AI to do your psychotherapy research or treatment planning for you—here’s a link to Shedler calling out formerly-known-as-twitter’s AI Grok, which “literally gets everything wrong” in its summary of his work, including making up a fake effect size that reverses the implications of the research.
This video is a part of psychotherapist Elliot Greenbaum’s YouTube Channel Picturing It with Elliot, which has some other really cool videos. I ran across the channel searching for Nancy McWilliams videos, including this one about defining mental health.