The circular firing squad of pioneers, providers, and pundits

I am as cranky as anyone when celebrity therapists over-hype their approaches, especially when they seem to occupy more pedestal space than they merit. But I’ve been disheartened by what looks to me to be a trend in professional articles and blogs criticizing others’ work and tools, sometimes with invalid arguments.  

While it’s true that some emperors have no clothes, these days you can find “research” either exalting or demolishing almost any clinical model. In my fourth decade as a licensed therapist who still learns every day, I generally find that the truth usually lies somewhere between those conclusions.

Healthy skepticism is essential: Our promise to “do no harm” conveys the responsibility to question the validity and especially the safety of everything we practice.  But the promise is aspirational, because ongoing learning inevitably reveals that some things we believed years ago were misguided or even harmful, and things we dismissed were valid and therapeutic. Our duty is to strive earnestly, knowing certainty will always elude us. And to not act more sure of ourselves than we can actually be. 

We do ourselves and our patients no favors by getting too dogmatic about techniques, tools, theories, and models when the most replicated and reliable research consistently shows that therapeutic outcomes are shaped far more by the therapist – especially the therapeutic relationship – than by adherence to theoretical orientation or technique.

Our field, in response to its historical fight for legitimacy, and inclusion within medicine,and against stigma has responded with ever more medicalization of psychotherapy. (ie, if someone presents with symptom X, give them intervention Y.  Is it backed by neuroscience?  Does it produce consistent results?)  In so doing, the profession risks retreating into a rigid, technician-like posture that disconnects us from the relational core of healing.

Consequently, we tend to disparage things discovered by accident, whose mechanisms we don’t fully understand, or that work well for some clients and situations but not universally.  We sometimes pile on with moral outrage when a model is attacked, even when the attack uses vague appeals such as “science says” or “experts agree, ” leading to discarding or distrusting something valuable and to undermining colleagues who use it responsibly and effectively. That kind of public self-sabotage harms our field by eroding trust among the people who rely on us.

Some recent critiques of clinical tools – Measurement-Based Care, IFS, the MBTI, Love Languages, and Brainspotting, among others (all of which I use) – suffer from several common flaws. They often set up straw-man arguments, judging an approach against a standard it never claimed to meet; rely on ad hominem attacks on the founders; dismiss clinical observation as “non-scientific;” or criticize a method for being challenging to master. Some objections boil down to discomfort with aesthetics: processes that look strange, feel awkward, or resemble something “scary.” Others generalize too broadly from anecdotal accounts of harm that likely resulted from unskilled, unethical, or distorted practice rather than from the model itself. The halo effect also plays a role. If we dislike the person who champions a modality, we are inclined to reject the modality itself.

As one example, a highly critical article in The Cut uses specific horrific practices documented at an eating disorder treatment program to attempt to generally discredit the entire Internal Family Systems model. Readers unfamiliar with IFS might conclude that the model itself is dangerous, when the real issue appears to be unethical and unskilled practice, much of which runs contrary to IFS principles. The interventions described – including coercion around traumatic memory – violate what IFS actually teaches. A different theoretical frame applied with the same irresponsibility would likely have produced similarly catastrophic outcomes.

Similarly, I’ve read countless “debunkings” of the Myers Briggs Type Indicator (MBTI) that misunderstand its purposes, including saying it’s invalid for hiring decisions (Myers and Briggs explicitly warn against using it for that). Critics object that type can change over time (it can, and developmental change is one of the framework’s strengths), that no research supports it (there is an enormous body of validation and correlation studies), or that preferences aren’t binary (they aren’t, and the assessment’s forced-choice design helps reveal strength, not absolutes). The tool never claims to define people, and qualified practitioners use it collaboratively, not prescriptively. If we discard the MBTI on the basis of these flawed critiques, we lose a helpful tool for clients exploring career paths, understanding relationship dynamics, and cultivating self-acceptance.

Love Languages were never meant to define a rigid taxonomy of affection, but to expand the ways people can express and receive love. Measurement-Based Care is often vilified because some institutions misuse it to evaluate therapist performance, though its intended purpose – usefully tracking clients’ perceptions of change and alliance for the purposes of discussion and self-development for the clinician– can be invaluable when used ethically. Misuse should not negate clinical value.

I’ve seen similar turf wars elsewhere: some advocates of Emotionally Focused Therapy

dismiss the Gottman Method as unscientific, and some Gottman proponents imply EFT is too “soft.” Psychoanalyst Orna Guralnik has described both approaches as “communication coaching,” suggesting they lack the depth of psychoanalytic work. Yet all three approaches help countless couples.  And any can be harmful in the hands of unskilled or unethical providers.

So what can we do?

Most importantly, we can reduce hostility and increase curiosity. Ethical violations need accountability, yet we should resist reflexive pile-ons, recognizing that any of us may someday watch something we rely on become the next target of oversimplified criticism.  Related to that, we must remain alert to our individual and collective professional response to the commodification of psychotherapy. Our aim should not be to become the most technically compliant performers of particular methods. Our aim is to elevate learning – our clients’ and our own – in service of the brave and intricate developmental journeys that define human growth.

Acknowledging that we operate in an incredibly complex context can move us away from perceiving any model as wholly good or wholly bad. Reality is more complicated. The best therapists remain open to new tools and techniques that broaden how we and our clients understand inner experience, relationships, and behavior.  When we do question, we can critique cautiously, with humility about the complexity of the work we do, and an awareness of how easily certainty hardens into dogma.