Prince Harry and the problem with therapy

Following the publication of Prince Harry’s colorful memoirs, Replacement, we might wonder if he is the first person in history to kiss and give himself away. The duke’s well-publicized desire for privacy does not mesh easily with the many intimate confessions in his book, some of them tragic, many of them in poor taste. Like flies on a sun-drenched wall in one of his therapy sessions with Montecito, millions of readers around the world are now enjoying Harry’s detailed revelations. He has long advocated for speaking positively about mental health. But now his revelations raise many questions about the success, or otherwise, of psychotherapy.

media doctor Dr Max Pemberton he worries that the prince is “a bad advertisement for the many benefits of therapy”. Others have criticized the way in which Harry’catastrophes‘ every minor illness. Even high-ranking royals have weighed in on the debate. In an engagement in Liverpool, just a few days later Replacement hit The Shelves, Kate Middleton he pointedly suggested that “talk therapies don’t work for some.”

As one of the few health researchers who has dared to put psychotherapy on the couch, I welcome this wave of skepticism, belated though it may be. That now infamous skirmish between brothers and the breaking of the dog bowl detailed in Replacementfollowed by Harry’s rush to speed dial his therapist, it serves as a valuable warning of the shortcomings of psychotherapy.

It is crucial to emphasize that psychotherapy is not all bad. Harry often says that speaking cures can be highly effective, and research indicates that it is right. Unlike taking pills to relieve depression, therapy can prevent further mental health problems. But while psychotherapy has proven benefits, its potential for unpleasant side effects has hardly been examined.

In the UK, psychotherapy remains not regulated by law. That means it’s legal for anyone in britain to set yourself up as a therapist and declare your healing potential. This lack of professional regulation can mean that people experiencing mental health problems, when they are at their most vulnerable, may be subjected to harmful practices dispensed by unregistered professionals.

Also, while therapists always encourage self-exploration among their clients, they rarely examine weaknesses in their own practice. This is despite the fact that some researchers estimate that as many as one in 10 people experience a worsening of symptoms after long-term therapy.

Meanwhile, therapists charge by the hour, not by result. Therefore, if a client’s mental health worsens during sessions, they can always be encouraged to keep coming back and work more on themselves.

There are also double standards in psychotherapy when it comes to ‘sharing’. Therapists may say it’s good to talk, but they tend not to divulge too much about their own services. Many patients have only a vague impression of what happens in the sessions and why. Unfortunately, there is a very good explanation for this: many therapists have only a tenuous understanding of how therapy works.

Whichever version of treatment therapists practice, some will speak of ‘cognitive restructuring’, others will refer to Freud’s ‘phallic’ stages of development (in Replacement Harry refers to his ‘todger’ more than 15 times) – their jargon tends toward the pseudoscientific. Often this does not take cutting-edge psychology and neuroscience into account, as most therapists prefer theory. I have first hand experience of this myself. A therapist once suggested that he look for my ‘inner child’. Suspecting that there is no juvenile homunculus living in my brain, I never went back.

Perhaps unknowingly, Harry’s mental health activism has highlighted the current prevalence of many curious-looking cures. In a televised therapy session in 2021, Harry was shown touching his chest. to channel their traumas. He was demonstrating ‘eye movement desensitization reprocessing’ (EMDR) therapy. You may be surprised how often this practice is recommended.

There is serious scientific debate about the relative effectiveness of the hundreds of different types of therapy. but some studies show that the type of therapy itself might be less important than the quality of the practitioner. A large body of evidence shows that positive outcomes are associated with a therapist’s empathy, client expectations, and a good working relationship between the two people in the room, regardless of the mystery techniques the therapist employs. What may matter more is the patient’s belief in the therapy and her attachment to the therapist. In the age of ‘sharing’, it would be useful for paying customers and broken health systems to know these things.

So while it is true that therapy can be highly effective, it certainly suffers from a fragile relationship to fact.

Worse still for truth-seekers, restoring clients’ good sanity often requires you to put on rose-colored glasses. People who are mildly (but not severely) depressed tend to exhibit a greater degree of realism about their lives, a phenomenon known as ‘depressive realism‘. On the other hand, psychologists have long recognized that Pollyanna-like delusions, such as an exaggerated view of popularity, intelligence, good looks, or a sense of control over events, are associated with positive well-being.

In fact, achieving positive mental health, which is the goal of therapy, can inevitably mean that our personal relationship with the facts goes a bit off track. In other words, therapy is fertile ground for cultivating egotistical ‘truths’: personal narratives that elevate the client from helpless victim to protagonist hero. Could the Duke of Sussex have benefited from such fictional salves? He couldn’t tell.

charlotte blease is a Digital Psychiatry Research Affiliate at Harvard Medical School and Uppsala University, Sweden. Follow her on Twitter: @crblease