To the Editor:
Re “Not Everyone Should Be in Therapy,” by Harvey Lieberman (Opinion guest essay, July 10):
As a therapist working in community behavioral mental health, I found myself agreeing with much of Dr. Lieberman’s essay, particularly his observation that “unhappiness is often not a disorder, but a structural condition.” Nearly all of my clients fit that description: They are grieving, isolated, financially strained or disconnected from community.
Where I part ways with Dr. Lieberman is his conclusion that “when distress is shaped primarily by situational difficulties or the absence of community, therapy may not be the best fit.” Later, he writes that “part of the confusion lies in what therapy reliably provides.”
I agree that therapy cannot create affordable housing, repair fractured families or replace meaningful friendships, yet it does not promise any of those things. What it can do is provide the very structural conditions under which happiness is able to re-emerge.
In my work, I am not simply trying to give clients tools to alleviate distress. I am trying to create those structural conditions, if only for an hour. Sometimes that hour is the only place a client remembers how to laugh or reconnect with a sense of self that has been buried beneath grief, loneliness or instability.
If unhappiness is often structural, perhaps a consistent, caring relationship is itself one of the structures people need. The relationship may be intentionally created, but that does not make the care any less genuine.
Samantha Shapiro Philadelphia
To the Editor:
I agree that therapy cannot replace friendship, community or better life circumstances, but Harvey Lieberman’s essay creates the perception of a false choice. For many people, therapy is what helps them build those relationships and make beneficial changes. Many don’t have trusted friends or healthy families to turn to, and a skilled therapist offers far more than “a listener.”
Many of us carry trauma or unresolved emotional wounds that shape how we respond to life’s circumstances. Therapy can help people recognize and heal those patterns so they don’t keep repeating them. In a society in which many still avoid therapy because of stigma or self-doubt, this essay risks discouraging those who need it most. Therapy should complement community, not compete with it.
Frederick Smith Captain Cook, Hawaii
To the Editor:
As a psychotherapist with 45 years of experience, I applaud Harvey Lieberman’s essay.
I would add, however, a point that the essay did not touch on: the potential healing abilities of the relationship between a client and a therapist.
There is powerful work that goes on in effective psychotherapy that is attributable not only to the alliance between therapist and client but also to the connections and disruptions in that relationship that become a potent source for the client’s emotional development and maturation.
This all takes place alongside the conscious work of focusing on topical concerns as well as the addressing of unconscious patterns that a client is repeating out of past hurts that enables certain life struggles to perpetuate. A therapeutic relationship between client and therapist becomes an essential tool in itself.
Shelley Smithson Elk Rapids, Mich.
To the Editor:
The problem Harvey Lieberman identifies in his essay tracks with the work of some of the 20th century’s most noted social psychologists, like Erich Fromm, and sociologists, like C. Wright Mills. Even Freud in his later works, like “Civilization and Its Discontents,” moved his focus from the unconscious and repression to their relationship to dominant social structures.
Mills’s notion, in particular, of the “sociological imagination,” defined as the ability to understand our personal troubles as public issues, perfectly captures Dr. Lieberman’s insight that “unhappiness is often not a disorder, but a structural condition.”
From screen addiction and depressive loneliness to impostor syndrome and defiance disorder in rebellious adolescents, it’s time we all start to think more critically about the social structures that are causing these feelings and behaviors rather than pathologize them.
Eric Weiner New York The writer is a professor of educational sociology at Montclair State University.
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