The Dilemma of Mainstream Psychotherapy

If you’ve ever searched for a therapist, you’ve likely encountered a landscape populated by “experts” offering to “diagnose” and “treat” specific “conditions.” This is mainstream psychotherapy today: a clinical approach with a pathological view of human struggle, promising a cure through branded methods validated by “science.”

Growing up at the junction of Eastern and Western worldviews gave me the advantage of not being trapped in either. As a result, I never believed that matters of the heart and soul could be truly understood through book knowledge or dealt with by technical skills, which are void of the very substance they seek to heal — the lived human experience. Nor could I be convinced that the living problem that is me could be mechanically fixed like a broken engine by someone else. In my own past attempts at therapy, I found myself sitting across from a highly qualified expert, “experienced” in professional dealings but not in life, who was never able to touch me.

Human Connection: What Really Heals in Therapy

The great irony, one that the system itself is slow to acknowledge, is that its own scientific research dismantles its core assumptions. Groundbreaking work by psychologists like Bruce Wampold reveals a truth we often feel in our bones: the technical bells and whistles are not the primary agents of change. The factors accounting for therapeutic effectiveness are:

• Extratherapeutic factors (your own strengths, social support, life circumstances): 40%
• The client-therapist relationship: 30%
• Placebo and expectation: 15%
• The specific modality or technique: 15%

Let that sink in. The biggest factor within the therapy room itself is the human connection. Decades of research have failed to find significant differences in effectiveness between modalities, making the therapeutic alliance one of the few consistently replicated findings. As Anderson and his colleagues argue in the seminal book, The Heart and Soul of Change, “any model and associated strategies is not critical to success. Rather, each merely offers an opportunity for engagement.” Wampold drives the point home: “Psychotherapy is not a treatment administered to a client, but a process in which the client is engaged.”

Look back to the founders of the field. Sigmund Freud and his mentor Josef Breuer formed quasi-familial relationships with some patients, spending long hours with them, offering gifts, and corresponding extensively—efforts that far exceeded theoretical boundaries. Critics have rightly suggested that improvement in these cases likely owed more to this genuine empathy and attention than to any interventional technique.

Psychotherapy as a Cultural Ritual

If we look closer, we find that expectation and technique are woven into the fabric of the relationship itself. This alliance is formed within a cultural context, comprised of a shared rationale (a “myth”) about healing, a setting that assigns roles, and a ritual that structures the process, as argued by psychiatrist Jerome Frank in his heavily cited work, Persuasion and Healing.

He states powerfully: “Whether conducted in a shaman’s hut or a western hospital, the setting in which a treatment occurs imbues the process with power and prestige… the power of any therapeutic rationale to persuade is influenced by the culture from which it derives. In devout cultures, religious rationales may have the greatest therapeutic power. In our secular society, such power derives from science.”

Cultural Fit vs. Expertise

Quoting Frank, Anderson et al. elaborate that the currency of therapeutic explanations waxes and wanes as culture evolves. From a historical perspective, the “truth” of a rationale is relatively unimportant; the key to success lies in finding a rationale “in agreement with [the client’s] own ideas about psychic functioning.” Similarly, a specific modality serves no substantive purpose, but functions as an “opportunity for engagement” and a “placebo delivery device.”

For a client whose personal worldview aligns with the scientific one, “evidence-based” treatment can feel like a natural fit. But those from a different culture, with a religious background, or with spiritual aspirations often find themselves disillusioned.

This presents a paradox. Although I’ve been presenting arguments relentlessly for the inadequacy of clinical psychology and the necessity of the philosophical approach to mental wellbeing, I understand that the basic purpose of my contents is not convert those who will believe in the clinical approach in no matter what, but just to share my views in hope of reaching those who would see my point and resonate with it.

Curing Psychotherapy through Philosophical Reflection

Philosophical healers from within the field of psychology/psychiatry (Erich Fromm, Abraham Maslow, Carl Rogers, Irvin Yalom, to name a few) have all pointed to a challenging yet empowering reality: pain is not always a pathology to be eliminated; it can be a natural part of growth that is to be overcome by the human spirit; ultimately, overcoming life’s obstacles is a matter of willingness and responsibility. This demands a fundamental shift: I stop seeing myself as a victim and or a passive sick patient, expecting others to change or for others to change me. Rather, I must reclaim my status as a moral agent and actively change my way of being in the world.

That said, I must be clear: I am not dismissing the need for clinical intervention. I have myself experienced a state of mind so sick that it was beyond any possibility of self-redemption — a state I would, in retrospect, call a real mental illness. I see, in line with the pioneers of third-wave therapies that unprocessed trauma can become buried in the body, cut off from conscious access, in which case I could fully appreciate the utility interventions with a biological component, such as medicine-assisted psychotherapy or EMDR. Just as a severe physical illness requires drugs and medical care, so too does a psychological one.

Although I don’t necessarily follow all the way with Thomas Szasz who dismisses mental illness as merely a metaphor, I do agree with him, as with other philosophical healers, that a great deal of what we pathologize as “mental illness” are in fact problems of living, stemming directly personal value and conduct. A person might habitually avoid social situations (labeled “social anxiety disorder”), habitually succumb to despair (“major depressive disorder”), or habitually organize their life around rituals (“OCD”) owing to disorientation or a lack of coherent understanding. Rather than a disease that a person inheres or contracts, these are unexamined habits rooting in personal choices. With proper guidance and discipline, through the holistic reconstruction of personal worldview, healing occurs as a moral achievement on the client’s part, a courageous work of self-reinvention, not a success in technical manipulation on the therapist’s part.

Thinking along this line, philosophical psychiatrists like R.D. Laing, Viktor Frankl and Thomas Szasz believe that the highest quality in the therapist is personal authenticity. They are a fellow traveller on the humaning journey, a “wounded healer” who has themselves faced darkness, disorientation, threats, has ventured to the edge of existence and integrated that into their conscious map of life. Offer guidance and companionship, however, they cannot walk the path for you.

Technical and Moral Convenience

While this may make sense to many of us, the temptation of purchasable salvation remains strong.

We are taught to believe only in what is measurable, standardized, and institutionally credentialed. We are also spoiled by capitalism’s quick-fix offers, eroding our patience for organic growth, which is often slow, frustrating and less predictable. Most dangerously, it encourages our already deep-seated resistance to self-responsibility, alluring us to sell our most original power for the illusion of convenience.

I say “illusion” here because, to be fair, capitalism has delivered real conveniences in many domains. However, I don’t believe there can be any convenience in the realm of moral struggle. Such inconvenience truth is embodied by practices like Vipassana meditation, which teaches radical self-reliance: “you suffer because you haven’t mastered your own mind, so put in the effort to train your mind and liberate yourself.” Notably, this path of self-transformation does not charge a dime.

Interestingly, many of us would still choose to trust paid services than free (priceless) teachings, services that are incorporated into the healthcare system and recognized by insurance companies, and as such function like a cog in the bureaucracy machine. Ironically, it’s not always easy to tell when a perfectly normal tendency to buy a sense of manufactured safety and socially sanctioned sanity becomes a sign of collective insanity.

An Impossible Profession

Despite its best effort to pretend a science, there is an internal contradiction within the clinical approach to psychotherapy. On one hand, it insists that its practice is based on systematically gathered data and objectively validated evidence. On the other, the very goal of the practice, namely, “health,” “normality,” and a “good life,” are essentially are value judgements, which in the first place determines what data to collect and defines what counts as evidence. “Whether the rationale is based on spirit possession, repressed childhood conflicts, or irrational cognitive schemas, it is a cultural construct, not a scientific fact,” says Frank.

Moreover, as we’re growing more aware, the scientific narrative is impotent in the face of human struggle, which fundamentally revolves around moral values. Values are the driver of our actions, the shaper of our perception, invisible pillars of our sense-making schema, and the lens through which we decide what is meaningful, what is good, and what is real.

The prefix of psychology comes from the Greek word “psyche,” which means the soul. Psychology is supposed to be a study of human virtue and happiness, but as Erich Fromm laments, from his time to present day, mainstream psychology deals with everything around but the soul itself; psychology has become a science missing its very subject.

Cultural Care for the Soul

Reaching a similar conclusion through clinical experience rather than philosophical reflection, Kenneth Pargament, a pioneer in spiritually-integrated psychotherapy, has rightly identified that “Psychological distress and spiritual struggle are deeply intertwined; attempting to disentangle the two would be as futile as trying to pull apart the black and the white threads of a grey sweater.” While I completely agree with his point, I find the term “spiritual” a bit misleading, given its usual association with “religious.” As Pargament himself states, the secular person can have spiritual struggle too. “Spiritual struggles are often existential in nature,” he acknowledges, wrestling with questions like “Who am I? Why am I here? How should I live my life? What is true? How do I make sense of suffering?

In my opinion, these are not any niche “spiritual” problems per se, but philosophical questions and moral struggles that is the basic experience of humaning as a meaning-making and self-creating, therefore a self-responsible process. More often than not, these struggles come with difficult, intense emotions and thoughts, but they’re not themselves the problem. Pain is not a problem when it is tolerable, i.e. if it is somehow meaningful. We can endure immense hardship for a cause we believe in, a person we love, or a future we are building. To the contrary, pain becomes completely intolerable when it seems meaningless. At the core of human struggle, the individual is struggling to see the meaning of his/her situation. At the soul level, the individual suffers not the pain itself but in disorientation as in the failure to see the direction in which one’s life is going in the midst of adversity.

As I’ve argued in my other blog, cultural traditions, whether religious or secular, have historically been the primary provider of moral compass and answers to life’s biggest questions. In this light, spiritually-integrated psychotherapy is essentially the practice of acknowledging different worldviews and understanding how they’ve influenced the client’s ability to navigate challenges. It is no wonder, then, that the APA groups spiritual and religious competence under multicultural competence.

The Healing Art and the Philosophizing Skill

In a sense, philosophical counselling is not very different from existential therapy and spiritually-integrated psychotherapy. The only difference is that a philosophical counsellor is actually trained in philosophy, not to memorize the thesis of dead thinkers, but to master the art and skill of philosophizing. With such training, a philosophical counsellor develops the capacity to understand diverse worldviews, to appreciate the architecture of various meaning-making systems, whether they are secular, religious, or mixed, and to help clients examine their own; to listen for into the deeper meanings beneath the surface of everyday language, to gauge possible alternative ways of seeing things and to detect underlying inconsistencies in the thoughts, in which our deepest source of distress lies.

Meanwhile, a philosophical counsellor is not primarily trained in psychological theories or diagnostic protocols, but, as we’ve seen, decades of clinical research confirm they are not the decisive factor in therapeutic effectiveness. Having said that, as someone who have also studied psychology, I’d say I’ve found the knowledge useful. Although not sufficient to serve as the the backbone of my therapeutic approach, psychology certainly adds richness and dimension to it.

Nobody is Expert in Being Human

This leads me to a more personal confession. Not eagerly but inevitably, I put my service on popular platforms and submit myself to what it demands of me. I conform to the popular form of authority expression by advertising my “expertise,” displaying credentials from recognized institutions and making professional-sounding claims. To be honest, though, those things should not be reason why you reach out to me for help. Personally I don’t think they matter at all. What matters, rather, is my own suffering, my own trauma, my own journey of learning and unlearning, my own effort in working through difficulties, my own experience of the unfolding of life and coming to a clearer understanding of its nature, and my own witnessing of my slow wobbly return to a state of relative wellbeing.

I don’t offer help because I feel confident in solving your life problems as if I am an expert in being human — none of my education or training would justify that. Rather, I am confident only in what I have personally been through, learnt through life and overcome with my own will. I offer help because I imagine my past suffering self could have benefited from my present self, so somebody else in distress could benefit too, if they resonate with my views. So I invite you to not to be fooled by my credentials but judge if my views make sense to you.

In the grand scheme of things, I see that supporting others further support my own growth too. But as a fellow human still on the path, learning how to do so in a proper way is the real practice — not the professional practice of psychotherapy, but the self-cultivation practice for the small container of life that is me.

If you have any questions about the findings or ideas mentioned in this article, please leave a comment!