Bad Therapy

Bad Therapy Plot Summary

Introduction

The mental health of today's youth is deteriorating at an alarming rate despite unprecedented access to psychological resources and interventions. This paradox forms the central investigation of this analysis: why has the dramatic expansion of mental health services coincided with worsening outcomes among children and adolescents? The evidence suggests a troubling possibility - that many well-intentioned therapeutic approaches may actually be causing harm rather than healing. Through rigorous examination of research data, clinical practices, and cultural shifts, we uncover how therapeutic interventions in schools, homes, and clinical settings have fundamentally altered how young people understand themselves and their emotional experiences. The medicalization of normal development, the pathologizing of typical emotional responses, and the undermining of natural resilience mechanisms have created perfect conditions for psychological fragility. Understanding these iatrogenic effects - harms caused by treatment itself - offers a pathway to reconsidering our approach to youth mental health and restoring conditions that naturally foster psychological strength.

Chapter 1: The Treatment-Prevalence Paradox: More Help, Worse Outcomes

Despite unprecedented access to mental health resources, today's youth are experiencing a profound mental health crisis. This paradox forms the central concern of this investigation: why has increased treatment coincided with worsening outcomes? The evidence reveals a disturbing correlation between the expansion of mental health services and deteriorating youth wellbeing. For decades, we've witnessed exponential growth in mental health services. Since 1946, membership in the American Psychological Association has multiplied several times over. Between 1970 and 1995, the number of mental health professionals quadrupled. Nearly every decade since 1986 has seen mental health expenditure double compared to the previous one. This expansion has created a vast infrastructure dedicated to identifying and treating psychological distress among young people. This expansion creates a troubling contradiction. In other medical fields, increased treatment availability typically reduces prevalence and severity of conditions. When breast cancer detection and treatment improved, mortality rates declined. Better dental care meant fewer toothless Americans. Yet as treatments for anxiety and depression have become more sophisticated and accessible, adolescent anxiety and depression have skyrocketed. Academic researchers have termed this the "Treatment-Prevalence Paradox." Youth mental health has been declining steadily since the 1950s. Between 1990 and 2007 (before smartphones existed), the number of mentally ill children rose thirty-five-fold. Even more alarming, between 1950 and 1988, the proportion of adolescents aged fifteen to nineteen who died by suicide quadrupled. Mental illness became the leading cause of disability in children. This deterioration has continued despite - or perhaps because of - our increasing focus on mental health awareness and intervention. The mental health establishment has successfully convinced a generation that vast numbers of them are sick. Less than half of Gen Z believes their mental health is "good." Forty-two percent currently have a mental health diagnosis, rendering "normal" increasingly abnormal. This widespread pathologizing of typical experiences may be creating a self-fulfilling prophecy, where young people learn to interpret normal emotional responses as symptoms of illness requiring professional intervention.

Chapter 2: Iatrogenic Effects: When Mental Health Interventions Cause Harm

Iatrogenesis—harm caused by medical treatment—is a concept typically associated with physical medicine, but it applies equally to mental health interventions. Any treatment powerful enough to heal also carries the potential to harm. This fundamental principle is often overlooked in discussions about youth mental health, creating blind spots that allow potentially harmful practices to continue unchallenged. For decades, the standard therapy offered to victims of disaster—terrorist attacks, combat, severe injuries—was "psychological debriefing." This approach encouraged victims to process negative emotions in group sessions, recognize symptoms of PTSD, and continue therapy. Study after study has shown this bare-bones process actually worsens PTSD symptoms. Police officers who responded to disasters and underwent debriefing sessions exhibited more trauma-related symptoms eighteen months later than those who received no treatment. Burn victims showed increased anxiety after therapy compared to untreated patients. Therapy can lead clients to understand themselves as sick and reorganize their self-concept around a diagnosis. It can encourage family estrangement, compromise resilience, exacerbate depression, and undermine self-efficacy. Therapy may render patients more dependent on their therapists. These iatrogenic effects pose even greater risks to children, who lack the adult capacity to correct a therapist's interpretations or push back against their views. Children are particularly vulnerable to suggestion and may incorporate therapeutic narratives into their developing identities. Interestingly, even when patients' symptoms objectively worsen through therapy, they tend to assume the therapy has helped. We rely on how "purged" we feel after a session rather than tracking objective markers like the state of our relationships or career. This subjective sense of benefit can mask actual deterioration, allowing harmful practices to continue without scrutiny. The emotional catharsis of therapy sessions may feel helpful while actually reinforcing problematic patterns of thought and behavior. Therapy can hijack normal resilience processes, interrupting our mind's ability to heal itself in its own way and time. Group therapy for those who experienced loss or disaster forces the coping to interact with the sad, potentially making the resilient sadder and prompting the sad to ruminate further. By interfering with natural recovery mechanisms, well-intentioned interventions may prolong suffering rather than alleviating it. This risk is particularly acute for children, whose developing minds possess remarkable natural resilience when allowed to process experiences in their own way.

Chapter 3: Schools as Therapy Centers: The Transformation of Education

Today's schools have transformed into de facto mental health clinics, with educators routinely engaging in therapeutic practices despite lacking formal training. This shift represents a fundamental change in the educational mission, with significant consequences for student development and academic achievement. The therapeutic approach has permeated virtually every aspect of school life, from classroom management to discipline to curriculum. Many schools now begin each day with an "emotions check-in" rather than academic work. Teachers ask students: "How are you feeling today?" This practice, while seemingly benign, can actually undermine emotional stability. Emotions researchers have found that certain kinds of attention to emotions can increase emotional distress. By teaching children to attribute great importance to their feelings, schools may inadvertently encourage them to become more emotional and less resilient in the face of normal challenges. School psychologists, counselors, and social workers now form an expanded mental health staff overseeing virtually every school. Student outbursts that might once have earned detention now prompt scheduled therapy sessions. In 2022, California announced plans to hire an additional ten thousand counselors to address youth mental health concerns, with $50 million allocated for more mental health professionals in schools. This massive investment reflects the belief that psychological intervention is the appropriate response to behavioral issues that previous generations handled through discipline and structure. This arrangement creates ethical problems. Therapists typically avoid "dual relationships" where they interact with patients outside the therapeutic context. Yet school counselors know all a student's friends, teachers, and often their parents. They report to school administrators rather than to parents. This dual relationship with every student they counsel violates traditional therapeutic boundaries and creates potential for undue influence. Students may feel unable to truly confide in counselors who are embedded in their daily social environment. Social-emotional learning (SEL) has become a curricular juggernaut that consumes billions in education spending annually. Through various exercises, SEL pushes students toward personal reflections aimed at teaching "self-awareness," "social awareness," "relationship skills," "self-management," and "responsible decision-making." These programs often involve public sharing of personal experiences and emotions, creating potential for psychological harm when students disclose private struggles in classroom settings without appropriate therapeutic follow-up. The therapeutic approach has also transformed discipline through "restorative justice," which reimagines all bad behavior as a cry for help. Instead of punishment, schools implement "restorative circles" where offenders and victims discuss their feelings. This approach often revictimizes bullied students while failing to curb violence. Research shows schools implementing restorative justice often experience worsening academic outcomes with no reduction in violent incidents. By removing clear consequences for misbehavior, these approaches may inadvertently enable harmful conduct while denying victims the protection they deserve.

Chapter 4: The Trauma Narrative: Pathologizing Normal Experiences

Modern mental health discourse has become fixated on the concept of "trauma," expanding its definition to encompass virtually any negative experience. This broadening has profound implications for how we understand normal human development and resilience, particularly in children and adolescents. The trauma narrative has become so pervasive that ordinary childhood experiences are increasingly viewed through a lens of potential psychological damage. The notion that we all carry hidden childhood trauma has become culturally dominant. Bestselling books like "The Body Keeps the Score" by Bessel van der Kolk have popularized the idea that our bodies store traumatic memories, which require professional help to unearth. Van der Kolk claims that trauma can be "encoded in the viscera" and manifest as autoimmune disorders, anxiety, depression, ADHD, migraines, and even cancer. These claims, while compelling to many readers, often exceed the scientific evidence. Many leading academic psychologists and psychiatrists dispute these expansive trauma theories. Harvard psychiatry professor Harrison Pope calls van der Kolk's theory of repressed memory "methodologically flawed." Richard McNally, Harvard psychology professor, states unequivocally: "Memories are not stored 'in the body' [that is, in muscle tissue], and the notion of 'body memories' is foreign to the cognitive neuroscience of memory." These scientific critiques rarely reach the general public, allowing questionable trauma theories to shape educational and parenting practices. The ACE (Adverse Childhood Experiences) study has been widely misused to suggest that childhood difficulties inevitably lead to adult pathology. While the original research showed correlations between certain childhood experiences and health outcomes across populations, it was never intended to predict individual outcomes. Robert Anda, one of the study's authors, has expressed concern about this misapplication: "It's not appropriate to apply that average risk from a big epidemiologic study to an individual person." Resilience, not trauma, is actually the norm. Even among victims of heartbreaking circumstances, most people bounce back. Disturbing events are best understood as "potentially traumatic," meaning they may leave no lasting psychological imprint at all. Without clear evidence to the contrary, the best working assumption is that a child who comes to school from less-than-ideal circumstances can regulate emotions, complete assignments, and meet high expectations. The trauma narrative undermines this natural resilience by teaching children to view themselves as damaged. The trauma narrative has led schools to adopt "trauma-informed" approaches that treat every child as potentially damaged. This perspective can become a self-fulfilling prophecy. When children are treated as if they bear an incipient defect, they may come to believe it. The constant focus on potential trauma undermines children's natural resilience and teaches them they cannot overcome challenges on their own. Memory expert Elizabeth Loftus warns that treating all children as potentially traumatized can lead them to reframe their childhoods in a darker light, potentially creating false memories of trauma where none existed.

Chapter 5: Therapeutic Parenting: Undermining Authority and Resilience

Contemporary parenting has undergone a profound transformation, shifting from an authoritative model to a therapeutic approach that often undermines parental authority and children's development of resilience. This shift reflects broader cultural changes in how we understand the parent-child relationship and the nature of childhood itself. The consequences of this transformation are evident in children's behavior and psychological wellbeing. Today's parents have adopted therapeutic language and techniques when interacting with their children. Rather than issuing clear directives, they engage in lengthy explanations, negotiate endlessly, and constantly solicit children's input on decisions. "Sammy, I see that you're feeling frustrated. Is there a way you could express your frustration without biting your sister?" This approach replaces traditional parental authority with a therapist-like stance that treats children as clients rather than dependents requiring guidance and boundaries. Research by psychologist Diana Baumrind identified three parenting styles: permissive, authoritarian, and authoritative. Her studies consistently found that authoritative parenting—combining warmth with clear boundaries and consequences—produced the most successful, independent, self-reliant, and emotionally regulated children. Yet contemporary parents, while claiming to be "authoritative," often practice a more extreme version of permissive parenting that both indulges and micromanages children, creating confusion about boundaries and expectations. Many parents today avoid saying "no" to their children, regard time-outs as cruel, and refuse to isolate misbehaving children in their rooms. Even in response to violence, they offer no correction or judgment, merely stating their preferences: "I don't like it when you hit me." This approach fails to teach children self-discipline or respect for others' boundaries. Without clear limits and consequences, children lack the external structure needed to develop internal regulation. The consequences of this parenting style are evident in children's behavior. Parents report children who refuse to comply with basic requests, throw violent tantrums, and show contempt for parental authority. Online parenting forums are filled with desperate accounts of three-year-olds who punch their parents in the face, throw objects at siblings, and seem impervious to consequences. These behaviors reflect not innate defiance but confusion about boundaries and expectations. This therapeutic approach has created a generation of parents who find parenting miserable and exhausting. By treating their children as emotionally fragile and giving them inappropriate power, parents have inadvertently made their children more anxious. Children sense when adults aren't truly in charge, and it frightens them. They don't believe parents can help them because parents have repeatedly communicated that they aren't actually in control. This dynamic creates insecurity that manifests as anxiety, defiance, and emotional dysregulation.

Chapter 6: Medication Nation: Drugging Rather Than Disciplining Youth

The dramatic increase in prescribing psychiatric medications to children represents one of the most concerning trends in youth mental health. Rather than addressing behavioral issues through consistent discipline and structure, parents and schools increasingly turn to pharmaceutical interventions that alter brain chemistry without addressing underlying developmental needs or environmental factors. When four-year-old Maayan showed signs of hyperactivity and inattention in preschool, his doctor immediately diagnosed "severe" ADHD and recommended Ritalin. His father, Yaakov Ophir, a clinical psychologist, found himself questioning whether ADHD truly qualified as a disorder and whether medication was appropriate. With over 10% prevalence in the United States and 20% among Israeli youth, ADHD hardly meets the criterion of "deviance" that defines true disorders. The trait simply makes it harder to sit still for long hours in traditional classroom settings, but may even be advantageous in certain careers like venture capital or the military. Stimulant medications like Ritalin, Adderall, and Concerta are powerful psychoactive drugs that cross the blood-brain barrier. Studies show they pose high risks of dependency and addiction, may become less effective over time, and unlike behavioral interventions, discontinuing them returns a child to square one with added withdrawal symptoms. These medications alter developing brains in ways we don't fully understand, potentially affecting personality, creativity, and long-term neurological development. For anxiety and depression, medication presents similar concerns. Notre Dame psychology professor Scott Monroe expressed hesitation about prescribing antidepressants to adolescents: "They're powerful drugs, and the brain systems haven't solidified in adolescence. Male forebrains don't really come together until almost the mid-twenties." Regarding antianxiety medications, Vanderbilt professor Steve Hollon noted they're "about as effective as alcohol and only slightly more addictive"—they blunt pain but don't cure underlying issues. Unlike adults who choose to begin psychotropic medications, medicated adolescents may never discover whether they can handle life's challenges without pharmaceutical assistance. If teens aren't allowed to face difficulties, they never learn to weather them. When asked what we'd expect to see in a society that indiscriminately medicated moody or nervous teenagers, Hollon replied simply: "Oh, they wouldn't learn to cope." This observation highlights the developmental costs of chemical interventions that prevent young people from developing natural resilience through facing and overcoming challenges. There are costs to eliminating anxiety and depression beyond side effects. Both emotions serve evolutionary purposes. Anxiety evolved to make us alert to potential dangers, increasing chances of escape from threats. Depression serves to protectively shut down the system after we've been overpowered, allowing us to withdraw, retool, and contemplate different approaches. By chemically suppressing these adaptive responses, we may interfere with important psychological processes that contribute to growth and development. The rush to medicate children often begins in schools. When a child struggles to sit still or follow directions, teachers frequently suggest evaluation. The implication: medication might make everyone happier. This approach shifts responsibility from teaching children self-regulation to chemically altering their brains to fit institutional expectations. It prioritizes classroom management over children's long-term development, potentially sacrificing their psychological autonomy for adult convenience.

Chapter 7: Restoring Resilience: Alternatives to the Therapeutic Approach

The evidence suggests that many current approaches to youth mental health may be exacerbating rather than solving the crisis. Restoring conditions that naturally foster resilience requires reconsidering fundamental assumptions about child development and psychological wellbeing. This reconsideration points toward alternatives that may better serve young people's long-term interests. The first step involves recognizing that many normal emotional responses have been pathologized. Sadness, anxiety, anger, and frustration are not disorders but natural reactions to life's challenges. By treating these emotions as problems requiring professional intervention, we teach young people to fear their own emotional responses rather than developing the capacity to understand and manage them. Reframing these experiences as normal aspects of human development can help restore confidence in natural resilience. Limiting technology use represents a crucial intervention. The correlation between smartphone adoption and declining youth mental health is too strong to ignore. Setting clear boundaries around screen time, particularly social media use, creates space for face-to-face interaction, physical activity, and unstructured play. These activities naturally support psychological wellbeing in ways that digital interaction cannot replicate. Parents and schools that implement technology limits often report significant improvements in mood, sleep, and social connection. Restoring appropriate independence and responsibility provides another powerful alternative to therapeutic intervention. Over recent decades, children's opportunities for unsupervised play, independent mobility, and meaningful contribution have dramatically decreased. This shift has deprived young people of experiences crucial for developing confidence, competence, and resilience. Gradually expanding the scope of children's independent activity as they develop supports the natural progression toward autonomy and psychological strength. Authoritative parenting—combining warmth with clear boundaries and consequences—creates the secure foundation children need to develop emotional regulation. When parents communicate confidence in their authority and their children's capacity to meet expectations, they foster both security and competence. This approach stands in stark contrast to therapeutic parenting that treats children as emotionally fragile and gives them inappropriate power in family decision-making. Schools can support resilience by returning to their educational mission rather than functioning as therapeutic centers. This means maintaining high expectations for all students, implementing clear and consistent discipline, providing opportunities for meaningful responsibility, and focusing on academic content rather than emotional processing. When schools communicate confidence in students' capacity to meet challenges, they foster the growth mindset essential for psychological wellbeing. Community connection provides a natural alternative to professional intervention for many struggling young people. Extended family relationships, religious communities, sports teams, and other social groups offer emotional scaffolding that therapy cannot replicate. These connections provide not just support during difficulties but also a sense of belonging and purpose that protects against despair. Strengthening these natural support systems may do more for youth mental health than expanding professional services.

Summary

The mental health crisis among today's youth represents a profound iatrogenic effect—harm caused by the very interventions designed to help. Through an expanding array of therapeutic approaches in schools, homes, and clinical settings, we have inadvertently created a generation characterized by emotional fragility, dependency, and an inability to cope with normal life challenges. The medicalization of typical development, the pathologizing of ordinary emotions, and the undermining of natural resilience mechanisms have created perfect conditions for psychological vulnerability. The evidence reveals a disturbing pattern: as mental health interventions have expanded exponentially since the 1950s, youth mental health has steadily deteriorated. This "treatment-prevalence paradox" suggests that many current approaches are not merely ineffective but actively harmful. The solution lies not in more therapy but in restoring the conditions that naturally foster resilience: clear boundaries, appropriate consequences, reduced self-focus, progressive independence, and the opportunity to face and overcome challenges. Only by recognizing the iatrogenic nature of our current approach can we begin to reverse this troubling trend and help young people develop the psychological strength they need to thrive in an increasingly complex world.

About Author

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Abigail Shrier

Abigail Shrier is a frequent contributor to the Wall Street Journal. She holds an A.B. from Columbia College, where she received the Euretta J. Kellett Fellowship; a B.Phil. from the University of Oxford, and a J.D. from Yale Law School. She is a journalist.

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