Your Child (Probably) Needs Less Therapy Than You Think

Review: ‘Bad Therapy’ by Abigail Shrier

For months a room may have looked fine. Everything seemed sufficiently neat and tidy until, dust cloth in hand, spring-cleaning begins. Suddenly, the dirt accumulated over winter seems unending. The more I look for dirt, the more I find. That’s what makes deep cleaning so exhausting. (And why it’s easier just to put it off.)

The pursuit of ideal mental health can be the same. Every fleeting disappointment, frustrating moment, or sad feeling becomes a possible symptom of underlying dysfunction. Efforts to discover the roots of that dysfunction reveal more blemishes that need resolution.

In Bad Therapy: Why the Kids Aren’t Growing Up, Abigail Shrier takes a journalistic dive into the decline in mental health among young people in the West. Through reviews of clinical research and interviews of parents, children, and experts in various fields, Shrier makes her case that the growing ubiquity of therapy and therapeutic language is, in large part, to blame for the decline in mental health among teens over the past few decades, which is both a contributing cause and a result of the extension of adolescence. When we look for problems in our teens, we’ll find them in spades.

More Than Technology

Shrier’s book fits into the growing literature on the generation coming of age. Bad Therapy picks up themes that are also features of Ben Sasse’s The Vanishing American Adult, Jonathan Haidt’s The Anxious Generation, and Jean Twenge’s Generations. Each of them recognizes the kids are not alright. Plenty of anecdotal and empirical evidence supports their diagnoses from the different angles they adopt.

As an independent journalist, Shrier’s latest work builds on her investigative efforts in Irreversible Damage, but it expands the field of interest from the trendiness of transgenderism to broader concerns about adolescent mental health. According to Shrier, smartphones contribute greatly, but the triumph of the therapeutic is the most significant driver for increases in misery and self-centeredness of the rising generations.

To those familiar with 20th-century cultural analysis, the thesis of Bad Therapy should come as no surprise. It’s the logical, downstream condition of the shift Philip Rieff identifies in his 1966 book, The Triumph of the Therapeutic. According to Rieff, the psychological shift of Western culture—kicked off by Freud and those who followed him—turned the focus of humans inward to discover meaning. As Rieff notes, “Religious man was born to be saved; psychological man is born to be pleased” (19). But the quickest way to become unhappy is to focus on your own happiness.

Thinking About Frogs

It’s impossible not to think about frogs once someone tells you not to think about them. Similarly, hyperfocus on our children’s satisfaction with life and their achievement is a guaranteed path to dissatisfaction. Shrier argues, “The more closely we examined our kids, the more glaring their deviations from an endless array of benchmarks—academic, speech, social and emotional. Each now felt like a catastrophe” (xvi). Parents and teachers have pursued expert help to smooth out the bumps of childhood and adolescence. Formal and informal therapies have become the default solution to teenage dissatisfaction.

Shrier repeatedly reminds readers therapy can be necessary and helpful in some circumstances. But something is wrong when, as she notes, “Nearly 40 percent of the rising generation has received treatment from a mental health professional—compared with 26 percent of Gen Xers” (17). Simultaneously, teens are increasingly using information from social media influencers to self-diagnose various forms of neurodivergence and mental illness. As one clinician at Johns Hopkins writes, “Some of my teen patients have mentioned content from social media platforms during therapy sessions, often discussing how they feel they have certain symptoms. . . . At times this leads to a misunderstanding of a diagnosis or over-pathologizing of a symptom that is within the range of normal.”

The therapeutic mood fills the air we breathe. The number of mental health professionals has multiplied and the costs of pursuing ideal mental health have spiraled upward. Informal therapeutic ideas like self-care, mental health days, and emotional check-ins have become standard language for conversation. Yet the expansion of formal and informal treatments largely hasn’t improved general mental health, especially not for teens. According to Shrier, “Adolescent mental health has been in steady decline since the 1950s” (21). Why isn’t the increasing availability of therapy and the use of therapeutic language helpful?

Unintended Harms

The key concept in Bad Therapy is “iatrogenesis,” which “refers to the phenomenon of a healer harming a patient in the course of treatment” (7). Awareness of the risk of interventions drove the phrase in the Hippocratic oath “First do no harm.” As lengthy disclaimers in ubiquitous pharmaceutical ads remind us, every intervention, no matter how minor, carries with it some risks.

Rather than the rashes and bowel disruptions medications may cause, “bad therapy encourages hyperfocus on one’s emotional states, which in turn makes symptoms worse” (64). But since the therapeutic worldview has expanded beyond the counselor’s office, otherwise normal and healthy kids and their parents are being taught to consider their mental health and look for abnormalities.

Therapeutic language has also permeated the everyday world, including our educational system. It’s common, according to Shrier, for teachers to “inaugurate the school day with an ‘emotions check-in’” (71). Being asked to remember something bad happening at home or in the world first thing in the morning is a good way to get the day off to a bad start. When you look for dirt, you’re likely to find it.

Shrier cites numerous examples of this hypervigilance. A teacher suggests a child who repeatedly checks the clock at the end of the school day may have an anxiety disorder. The common definition of “trauma” has been expanded to include normal events “from the death of a pet or the routine humiliation of being picked last for a sports team” (19). Society has found therapy a valuable tool for situations of real psychological disruption, but like the man with a hammer, we’ve begun to see every emotional discomfort as a nail.

Overzealous Criticism

I’ve sat through enough corporate training and heard enough stories from school kids to recognize that Shrier is onto something. At times, however, her analysis veers into crankiness. For example, her story about some selfish, noisy children on an airplane comes off as drive-by criticism of a potentially flustered parent who had limited tools at his disposal (230).

There are also points where Shrier seems to ascribe ill intent to therapists, like when she points to profit motives driving counselors to keep healthy people in therapy (e.g., xviii, 12–13). There are bad actors in every field, but most are likely legitimately trying to help within the system they’ve been trained by.

And, of course, Shrier’s method of finding people to interview was largely by contacting experts whose opinions could be used to support her thesis or finding those who have had negative experiences with excessive therapy, so there’s selection bias in her sample. Shrier is a journalist, after all, not a clinical researcher. In general, her analysis passes the smell test, but sometimes it seems she’s dialed up the intensity a few notches too far.

Congregational Community

Many of Schrier’s suggestions for parents are ways to pursue a more traditional childhood: supervising less during play, providing fewer gadgets, encouraging kids to move on from disappointments, and reminding kids that they are under their parents’ authority. In trying to keep kids safe from potential emotional and physical harms, our culture is creating actual problems from an excessively therapeutic approach. Accordingly, Schrier argues, therapy and medication should be reserved for substantial mental health issues.

Shrier’s analysis also suggests that many of the real needs that drive people toward therapy can be met through the traditional forms of community that a local congregation is designed to provide. Meaningful membership allows for durable friendships to form. Older parents can provide insight to a generation of church members trying to figure out how to raise these kids that didn’t come with an instruction manual. For many of us who are dislocated from our extended families due to our modern economy, the local church is the family that can help draw us outside of ourselves.

Youth workers can help their students by banning phones and screens at gatherings. Even a few hours a week without anxiety-inducing electronics can be a blessing. Social media and therapeutic culture can make the present seem tyrannical to adolescents. One way to help reduce anxiety is to help kids see they’re part of something bigger by digging into Scripture, teaching church history, and helping them connect to other generations within the congregation. Most significantly, helping young people see the objective goodness of the real world that God created can help them resist the flood of bad news the therapeutic world trades in.

Therapy can be valuable in some circumstances. Medications can alleviate suffering. We need not reject legitimate uses of psychological care. Yet Bad Therapy encourages a critical examination of our culture’s approach to the therapeutic so that? church leaders can better understand and respond to the world’s demands.

Andrew Spencer (PhD, Southeastern Baptist Theological Seminary) serves as associate editor for books at The Gospel Coalition. He is the author of Hope for God’s Creation: Stewardship in an Age of Futility and Doctrine in Shades of Green: Theological Perspective for Environmental Ethics, editor of The Christian Mind of C. S. Lewis: Essays in Honor of Michael Travers, and a contributor to Baptist Political Theology. Spencer is an elder at CrossPointe Church. He and his wife, Jennifer, have three children and live in southeast Michigan.