Book Review: “Bullshit in Psychotherapy” by George Steinfeld

Book Review: “Bullshit in Psychotherapy” by George Steinfeld

This is a sweet and interesting book, with an obviously attractive title (well - attractive to me!), written as an autobiographical look back over his professional life as a therapist by the 80-year-old George Steinfeld. It is exceptional in its honesty, and it pulls no punches about delivering some uncomfortable home truths about this profession of ours. Many of George’s criticisms I find myself agreeing with, and many of his warnings to clients I wholeheartedly endorse. Here is a collection:

“It has struck me that after about 70 years of practising therapy in this country …  and more than 100 years since Freud’s time, there’s something wrong with clients not getting healthier. Recent work suggests that therapy can make people worse. It’s a useful idea to let clients know of this possibility.”

“Some of the bullshit is therapist driven, but some of it is client driven. Making this distinction is important in our work. Whenever there is money or ego (power)  involved, or some unmet needs of the therapist, we have to be on the lookout for bullshit.”

“One could spend years in therapy, and I’ve heard some have stayed 50 years, till they or their therapist died, with no concern as to whether it was helping. Sure, people changed, but so did people who never were in therapy, and there was and still is no clear relationship between therapy and change.”

“Private practice: now it really gets bullshitty! … As I sit and listen to clients, …  and I do happen to be an excellent listener, if I do say so myself, I often ask myself whether what the client is paying me is worth it. Other times I feel that no matter what the client paid it wouldn’t be enough.”

George’s disenchantment with psychoanalysis

He makes no bones about the fact that - although initially and for many years he was a true believer in psychoanalysis as practised in the US at the time, i.e. the 1960s -  he now thinks of it as one of the key candidates for bullshit. He is especially critical of its search for past origins to current problems and the assumption that insight is sufficient to change behaviour.
“I believed in psychoanalysis for years, in undergraduate and graduate school. And I believed in it when I came to

[…] my internship training. I was a true and firm believer that psychoanalysis and Freud had the truth, and I was going to use the truth to cure patients. I believed the mental health field wanted to help patients get better, and  they were humanistically devoted to this process. As you will see, I was very naive, and I paid a painful price for that naivete.”

“We realise now that archaeological explorations into the past can only drag you down, even if we find the truth, which is unlikely to begin with. As stated, truth is in the mind of the beholder. But we certainly make up stories, most of which are self-serving, justifying our behaviour.”

He is thoroughly disenchanted with psychoanalysis, and he does tell some good horror stories about his experience of it:
“I was still being supervised by analytic supervisors and following the party line. My supervisor listened to tapes of my sessions and guided me to analyze the patient’s communication. The theory was that if we understood the patient’s cryptic communication, we could analyze them and through this process, the patient would improve or at least get better. This was and still is, in some circles, one of the greatest bullshit story of all times.” “[The supervisor]  would have us play the tape, and after about a minute or two, he said stop the tape. His classic line, told to every new intern, as we subsequently discovered, was simple. He matter-of-factly stated, after the short time he listened, that the rest of therapy would be undoing what we had done in the first few moments of the session. You can imagine how devastating this could be for a newbie. We’d never make it. What it taught us was to do what [the supervisor] suggested for the first few minutes of the session, since that’s what he only listened to, and then do what we felt we should do based on our feelings and thoughts and based on what we were reading and discovering from others. We did not have the courage to confront him with what we felt was bullshit. So we bullshitted as well.”

Once he had dismissed psychoanalysis in the 1970's, and committed himself to behavioural therapy (especially Ellis’ rational-emotive version of it), and then TA, family therapy, and more recently the energy therapies, he clearly did not bother to follow the further developments that have led to the wide-spread supersession of ego-psychology by relational psychoanalysis in the US.

One flew over the cuckoo’s nest - well, a whole generation did

The second main candidate for bullshit in therapy and in the mental health system is psychiatry and George’s fight for patients’ rights. By all accounts, he was exposed to some horrid institutions, very reminiscent of  “One flew over the cuckoo’s nest”, which he mentions. Fortunately for him, the anti-psychiatry movement and RD Laing kicked in just about as George and his mate Marty were about to be ground into the dust by the system. So he read Goffman’s “Asylums” and Szasz “Myth of Mental Illness” and was well on his way to becoming a 1960s radical (“Goffman  was describing mental hospital as a total institution, closed systems that could produce more suffering to inmates than it would have us believe. It took several more years to fully appreciate “Asylums” which I subsequently devoured as we confronted more bullshit down the road.”).
For most of us these days it is easy to take these criticisms of psychiatry and the mental health system for granted, benefiting - as we do -  from hindsight, and having grown up on Laing as essential reading in our early 20s. However, for George working within the system and then daring to rebel against it, these were formative and scarring experiences, including some personal betrayals and a lot of personal-professional bullshit.

“The most honest non-bullshit environment I have ever been in”

It is not surprising that he went on from there seeking integrity and things that worked for him. His conversion experience occurred when he started working in Therapeutic Communities in prison. Here is his description of his first day:
“He states he has feelings about Steinfeld, me, and he is encouraged to “get his feelings off”. He proceeds to confront me with my stupidity, with a variety of expletives that had me reeling and feeling as small as a mouse. Totally incompetent. I did not know what I was doing, I was killing the brother with my comments, and this young man directed me to essentially “shut the fuck up”. It took me some time to understand the process, and to gain the trust of the men. It was a great experience, and in light of the theme of this paper, I realised then and now that it was the most honest non-bullshit environment I have ever been in. No one, resident or staff, could bullshit or they would be called on it by anyone who observed it. No triangulation was allowed. You spoke directly to anyone you had thoughts of feelings about. No indirect bullshit was allowed.”

Many of his clients in the Therapeutic Communities were addicts, and from then on, addiction becomes the paradigm that is central to George’s  thinking about therapy. And this, it seems to me, circumscribes both the urgency, validity and integrity of his perspective as well as constituting his major blindspot and fallacy in how he constructs therapy (as I will discuss later on).

Developing therapies to seriously take on the many faces of bullshit

Following on from his experience in the Therapeutic Communities, George got thoroughly engaged in the psychotherapeutic profession of his time, and without making a meal out of it, the fact that he is very knowledgeable and well-versed in the developments of the field at the time (1970s and 1980’s especially) shines through in his descriptions of his further journey, summarised in these paragraphs:

“As I look over my years practising and learning and reading and writing, only a few workshops or conferences stand out as learning experiences incorporated into my practice. Ellis’ Rational Emotive training and related cognitive behavioural approaches, Transactional Analysis, energy healing procedures and family systems theory have captured my fancy. Even though I trained at the Mental Research Institute, the hotbed of brief, strategic treatment, with the best of the best at the time, I rarely use their procedures, though I like to think they encouraged us to think brief therapy. The other major influence of course has been the spiritual teaching of Ram Dass and other Buddhist scholars.”

“I began receiving training in Transactional Analysis, a non-bullshit approach to therapy (although some practitioners, I have learned, do not practice what they preach).”

“If you walk the earth wearing shoes, all you feel is leather. Thanks, Ram Dass. …  Since he has been so important to me, almost 40 years of having him in my life …  frequently quoting him, with pictures in my office and I carry him with me throughout my life.”

“My clients have taught me much over the years. Much more than my supervisors had. That is, except for Albert Ellis, with whom I trained in the mid-70s. That was my first introduction to cognitive behaviour therapy on a formal teaching basis, although I had been reading about it many years prior. I don’t recall many of my encounters with Ellis during the actual training. My wife saw him several times. In addition to telling her to put away all the horse shit she was reading, analytic crap as he referred to it. It was hard for her to do that, being a trained analytically-oriented social worker. But she felt very safe with him, despite him telling her she was very attractive. He had great integrity and she felt it, unlike previous therapists she had seen. … Ellis also told my wife I was the most stubborn person he ever met, a truth that was hard for me to accept.”

There are frequent indications throughout the book that Ellis’s feedback might have a kernel of truth:

“I personally have a little problem with strategic therapy, as practised by some, whereby they encourage interventions which are geared to have a positive effect, but the client is unaware of the process. I realise this is my issue. …  my personal inclination is to explain the therapy process to the client, tend to normalise their experiences and their issues, and see if they are willing to engage in the change process. …  There is something unequal in the relationship that concerns me. I guess I believe that everyone has the capacity to understand, and it’s their choice to do or not do something. …  as I write this, I’m confronting my own unresolved issues, perhaps anyone who reads this can help me clarify my thoughts and values on the matter. I think it goes back to feeling uncomfortable with the unequal power relationship in therapy, my experience of the hospital where patients had no say, whereas in the prison setting, the therapeutic community where I worked, there were, as previously stated, no ‘big mes and little yous’.”

Clearly, George does not believe in anything unconscious - he believes in taking responsibility and in behaviour change, as we will have to discuss later on. In summary, the book makes many valid critical points, not only about the particular times and situations that George struggled in, but more generally about the therapeutic profession - much of it is still valid today. His main bugbears are psychoanalysis, especially in the 1960’s ego-psychology version that he was exposed to in the US, and psychiatry, then and - much of it - now. Although George frequently owns up to the bias of his perspective - and such personal-professional owning up to the constructed partiality of one’s own ‘truth’ is of course a key element of his recipe for minimising bullshit, in psychotherapy and in life - he never quite gets over himself and his key assumptions. In giving an account of his professional life, he is very open about the path which his own seeking for ‘truth’ took, and also the outrageous and damaging bullshit which he encountered and is reacting and writing against.

My attempt to follow his invitation to help clarify his “thoughts and values”

However, following his invitation for colleagues to clarify his “thoughts and values”, I would like to suggest that George is making one - very common and ultimately misleading - fundamental assumption, with pervasive consequences for all of his thinking: that therapy is all about change and making change happen. This is very obvious to him because - without quite saying so - he takes one of his early client groups (i.e. addicts), as a default reference for the flawed human condition - there can be no doubt in his mind that an addict is in need of therapy, and that good, effective therapy will have to cure him of the addiction, so there is a clearly factual and tangible desired behavioural outcome. Put this together with the fact that the therapeutic community which helped him overcome his own trappedness in bullshit has become a foundation and reference point for all his later thinking, and you end up with one dedicated therapist pursuing his therapeutic mission of confronting addiction in all its sneaky and self-perpetuating and self-justifying forms and rooting it out.

We are all ‘dope fiends’ … who therefore need rational-emotive therapy

The central chapter of the book declares how George sees us all as ‘dope fiends’, operating by addictive magical thinking. He spends considerable time and space going through the multitudinous details and permutations of the irrationality at the root of addiction which calls for therapeutic intervention. And therapeutic non-bullshit effectiveness in his mind depends upon confronting that irrationality comprehensively and with quick results, manifested in changed behaviour.
So here is his 'credo':
"I define the ‘dope fiend’ as anyone who acts repeatedly in a self-defeating way,  whether or not he actually stick the needle in his arms, drinks himself into a stupor, […]  Thus, people who use drugs and alcohol, overeat, smoke compulsively, fantasise about their ‘knight in shining armour’, have obsessions and compulsions, feel hostile, depressed, anxious and guilty most of the time, who work excessively in their lives are all manifesting ‘dope fiend’ attributes.  in fact, excessive involvement in any activity, without balance […]  can be called addictive behaviour.  any excessive thoughts, feelings or actions which serve to block out other aspects of one’s existence are conceived to be ‘dope fiend’ tendencies. We are all ‘dope fiends’ unless we work toward overcoming our ‘7 deadly sins’,  first by embracing them as part of ourselves, and then through the grace of our work and a higher power, transcend them, as best we can. […] In all cases they select behaviour which invariably leads to a "losing life pattern (Berne 1974). ... In essence, all ‘dope fiends’ are (ignorant-unknowing of choices), manifesting a host of irrational (dysfunctional) thoughts and feelings and ignoring the consequences of their behaviour (Ellis, 1974).”

Because George quite rightly sees addicts as having a million ways of rationalising their way out of confronting their addiction - anything to perpetuate their habit - George is consequent in his judgment that any refusal to do something about it is bullshit, whether it is the client’s or the therapist’s refusal to get serious. He therefore isn’t interested in thoughts or words, or even good or bad intentions, or any inner psychological reality for that matter, unless it’s backed up with behavioural change. For George, this is the yardstick of therapy’s effectiveness and if it doesn’t deliver it, it's bullshit. For these purposes, the paradigm of rational emotive behaviour therapy appears to be just the ticket:
“According to REBT, it is largely our thinking about events that leads to emotional and behavioral upset. With an emphasis on the present, individuals are taught how to examine and challenge their unhelpful thinking which creates unhealthy emotions and self-defeating/self-sabotaging behaviors. REBT is a practical approach to assist individuals in coping with and overcoming adversity as well as achieving goals. REBT places a good deal of its focus on the present. REBT addresses attitudes, unhealthy emotions (e.g., unhealthy anger, depression, anxiety, guilt, etc.) and maladaptive behaviors (e.g., procrastination, addictive behaviors, aggression, unhealthy eating, sleep disturbance, etc.) that can negatively impact life satisfaction. REBT practitioners work closely with individuals, seeking to help identify their individual set of beliefs (attitudes, expectations and personal rules) that frequently lead to emotional distress. REBT then provides a variety of methods to help people reformulate their dysfunctional beliefs into more sensible, realistic and helpful ones by employing the powerful REBT technique called ‘disputing’.” (from the home page of the website:
And the practice of disputing George develops into an art form (that kernel of stubbornness that Ellis was pointing to). His assumption is that if therapy has any point at all, then it must be to get us over those addictive tendencies, somewhat closer to something resembling ‘mature grown-up reality’. By expanding psychology to include a spiritual perspective (we are all ‘dope fiends’ unless we work toward overcoming our ‘7 deadly sins’), he then extends the reach and scope of therapy way beyond addiction to particular substances: by identifying the addictive roots of the ego and its stubborn refusal of a spiritually enlightened perspective, addiction becomes the paradigm for all human suffering and the irrational mechanisms which perpetuate it. He then fights this pervasive addictive human flaw using all the tricks and tools in the book, including the spiritual book, as authored by Ram Dass and others.

The devil is not just in the detail - it’s in the ‘resistance’

Having made his description of the dope fiend the central chapter of the book, he is then confronted with the dope fiend’s resistance and non-compliance with the therapy as the central problem for the therapist.
But he never questions his own construction of therapy which is always already built upon his pre-existing and taken-for-granted notion of the dope fiend’s resistance to those desirable changes which George’s spiritually enhanced perspective has defined as required, or worth while, or as bullshit if avoided. The more he widens the category of addiction as the underlying driver and root cause of human malaise, the more entrenched the fiendishly subtle resistance against proper behaviour change appears to him. The key message of the book, therefore, regarding what is and isn’t bullshit in therapy, hinges around ‘resistance’ (“Part II: Patient Non-compliance: Resistance to Getting Healthy and Happy”) and how to overcome it.

The particular mixture of approaches that he has become attracted to speaks to him because of the active and helpful principles and strategies they give him in confronting and tackling resistance effectively. The integration of approaches which he has developed over the years and which he advocates includes only those that promise - in his experience - to combat resistance bluntly and to effect behaviour change quickly.

To be completed …

By |2017-03-07T19:53:39+00:00September 11th, 2016|Michael's Psychotherapy CPD Blog|0 Comments

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