To be fair, those hundreds of therapies mostly fall under one of three main tents — psychodynamic, existential humanist and cognitive behavioral (better known as C.B.T.) — plus a fourth that we might as well call influencer-driven because its unifying element is TikTok. But you would not believe the range of thinking underlying each.
Psychodynamic therapy, for starters, grows out of Freudian psychoanalysis, which remains the intellectual taproot of the entire enterprise. But it also hosts a bewildering diversity of thought. The psychoanalytic community alone churns with dialogue among classical interest in unconscious conflict, the attachment-theory concern with how patterns of childhood relationships influence adult lives, and the so-called ontological drift identified by Dr. Thomas Ogden, an influential writer who has been my own primary teacher as I have turned myself into a psychoanalytic therapist.
In Dr. Ogden’s framing, therapy’s power lies less in whatever knowledge it brings and more in the dreaming of one’s un-dreamt dreams — ways of feeling more fully the half-digested experiences that lie walled-off somewhere inside ourselves.
At the opposite extreme, C.B.T., which gets by far the most research attention, grows out of early-20th-century studies of how positive and negative stimulus can modify behavior. Applied to emotional behavior like a fear response, or cognitive behavior like the persistent thought that one is worthless, this can be enormously helpful. And yet, the most influential innovation in the C.B.T. camp has been Acceptance and Commitment Therapy, based on the idea that trying to modify thoughts often backfires and that we should focus instead on whatever we value most.
To make matters more confusing, most states require therapists to take continuing-education courses. New products sell better than old ones, so new therapies get branded on roughly the same cadence as soda flavors, with their own acronymic names. The biggest player in this space, PESI.com, channels Fast Eddy’s Discount Therapy Training Emporium with online seminars in, for example, Internal Family Systems, (I.F.S., naturally) a $1,319.78 value on special for $399.99.
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