A new national study by the Psychotherapy Action Network (PsiAN) reveals that most Americans still want therapy that helps them understand the root of their struggles. However, too often, what they get is symptom management, app-based interactions, or care shaped more by insurance reimbursement than by clinical insight.
In their study, The Therapy World Has Changed: Where Are We Now?, authors Santiago Delboy and Linda Michaels (co-founders of PsiAN) surveyed over 1,500 adults across the United States. Their results suggest that people still want the kind of therapy that takes time, fosters deep understanding, and treats the whole person. Yet many remain confused about what type of therapy they are receiving, or feel limited by cost, access, or digital platforms.
“The public’s preference for ‘getting to the root’ remains strong,” the authors write. “Nearly the entire sample preferred a therapy that ‘gets to the root,’ even if it takes longer.”
This research builds on PsiAN’s widely cited 2020 study, which found that 91 percent of respondents preferred therapy that addressed the underlying causes of distress. Despite a pandemic, the rise of telehealth, and a boom in mental health apps, that number remains virtually unchanged. Eighty-eight percent now say they would still prefer a longer course of therapy that addresses root causes over a quicker intervention focused solely on symptom relief.
Respondents also described what they value most in therapy as the experience of being understood without judgment, the chance to make meaningful changes in long-standing patterns, and the belief that therapy is a worthy investment in one’s growth and self-understanding.
“The core message is that therapy is a place where you will be heard and understood without judgment,” Delboy and Michaels write. “Therapy can help you change old patterns of behaviors, thoughts, feelings, and relationships to make new choices in your life.”
PsiAN, founded in the wake of a 2017 conference organized by the Chicago Center for Psychoanalysis, emerged from a growing concern that relational and insight-oriented therapies were being sidelined in favor of faster, more marketable approaches. Since then, the organization has taken on a dual mission: to educate the public about the value of depth-oriented psychotherapy, and to advocate for its protection amid the encroachment of industry priorities.
Their latest research shows that while public attitudes have remained largely stable, access to preferred forms of therapy has not kept pace. Only 11 percent of current or recent therapy clients reported receiving psychoanalytic or humanistic therapy. Most could not identify the modality they experienced, and many reported receiving therapy that emphasized “quick tips” or homework, interventions more aligned with short-term cognitive behavioral approaches.
You've landed on a MIA journalism article that is funded by MIA supporters. To read the full article, sign up as a MIA Supporter. All active donors get full access to all MIA content, and free passes to all Mad in America events.
Current MIA supporters can log in below.(If you can't afford to support MIA in this way, email us at [email protected] and we will provide you with access to all donor-supported content.)
I’m pretty sure that I can identify the therapy that harmed me most was some sort of psychodynamic therapy.
Report comment
I am even 100% sure about that.
The reason why I have survived is that I began practicing yoga and meditation in my twenties. I neither profitted from medication nor from psychotherapy. Therefore I was eager to try something else.
Over the course of the next fifteen years and with lots of formal mindfulness practice I broke through to the root cause of my bad mental health. The reason was that my mother had forced me to go see a psychoanalytic therapist when I was ten. It did nothing but harm me and left me with a deeply ingrained idea about myself that something was completely wrong with me.
Psychodynamic and humanist therapists did nothing but again and again fixate that belief about myself.
It was with my meditation practice that I cut through to the understanding that psychotherapy had not only been the original trigger for my bad mental health but also the most important thing that kept it so bad continually.
In my view, the psychoanalytic theories and the practice aren’t conducive to find out about the root cause of one’s struggles. It is not something that you should go looking for or dig for. It is just the other way around. The more you relax and stop running away from your pain the more your false ideas and confusions will dissolve and beneath it you will find out what was holding you back, and you will realise that you actually always knew.
Most importantly: No psychotherapist is needed to support us on that path. We are the first witnesses of our lives. We have witnessed it all. We have experienced it all. Therefore we know and understand. We neither need a guide, a leader, nor an interpreter with this.
In my experience even the best psychotherapists just add to the confusion that’s in the way of understanding because they haven’t learned to relax, bear their pain, and found out about themselves again in this way.
Therefore you don’t get anywhere even after twenty years of therapy. The only thing that’s possible with psychotherapy is that your confusion’s changed character after twenty years.
Report comment
Wow Lina, you put it so succinctly. Yes, it was only after I stopped trying therapy- I was led to believe I was broken- not by family or friends, but by the system- it was only then, did I find my peace and create my own path.
Report comment
“Psychodynamic and humanist therapists did nothing but again and again fixate that belief [‘illness’] about myself.”
“The more you relax and stop running away from your pain the more your false ideas and confusions will dissolve and beneath it you will find out what was holding you back, and you will realise that you actually always knew.”
“Most importantly: No psychotherapist is needed to support us on that path… We neither need a guide, a leader, nor an interpreter with us.”
Thank you, Lina!
It’s amazing how much better I felt once I stopped associating with professionals fixated on thinking something was the matter with me.
It never seemed to occur to any of them that they might be the ones with a problem.
I only wish your words could find a way to be re-embedded in the souls of every living human being.
Report comment
“… psychotherapy had not only been the original trigger for my bad mental health but also the most important thing that keep it so bad continually.”
Indeed.
Psychiatry’s DSM is the driving force behind psychotherapy’s longevity—without it, much of the profession might not exist as we know it.
Report comment
“In my experience, even the best psychotherapists just add to the confusion that’s in the way of understanding because they haven’t learned to relax, bear their pain, and found out about themselves in this way.”
Very true.
Few people seem to realize that therapy operates under deeply flawed assumptions that subtly condition people to believe they need an “expert” to make sense of their own lives. In doing so, this reinforces a form of unconscious molding—encouraging people to shape themselves in ways that gain approval from their therapist, much like a child seeking validation.
The more therapy positions itself as essential to self-awareness, the more it fosters dependency instead of true autonomy.
A truly helpful human doesn’t reinforce that cycle. They simply pose a few insightful questions, offer alternative perspectives, and then step back—allowing people to recognize their own capacity for understanding themselves and the world they live in.
The more therapy positions itself as essential to self-awareness, the more it inadvertently it encourages infantilization.
Report comment
Your comment is more insightful than all the therapeutic hypotheses I’ve ever read about.
Report comment
Why thank you, joel stern. I wish more people felt the way you do.
Report comment
“We are the first witnesses of our lives. We have witnessed it all. We have experienced it all. Therefore we know and understand.”
Absolutely breathtaking, like a psalm from the bible.
Report comment
I agree.
Perhaps people seeking therapy for depth work and have a more thorough consent process can benefit from this better. But that is not something I was seeking nor was I given any understanding of what to expect. It really was the worst experience to have during what was already a crisis.
Report comment
“authors Santiago Delboy and Linda Michaels (co-founders of PsiAN) surveyed over 1,500 adults across the United States. Their results suggest that people still want the kind of therapy that takes time, fosters deep understanding, and treats the whole person.”
Yet the “scientific fraud” based DSM “bible” based psychiatric / psychological, et al, deluded industries, went in the opposite direction.
But, since the scientific fraud based DSM deluded have already had their DSM be declared to be “invalid,” let’s hope someday soon those who work within those industries, may soon overcome their delusions of grandeur, that they are the judges of all of humanity, as opposed to that being God’s job. It’s “complex,” yet not that “complex” to those of us who know what is actually going on.
Let’s hope and pray, some day, that those of the “mental health professions,” who were unwisely given the role of playing “judge, jury, and executioner” to the masses … by our seemingly deluded governments and religions of Western civilization … someday understand the fact that God’s the ultimate judge, not the DSM “bible” billers … nor any government, nor religion.
Report comment
I have been receiving intensive “dialectical behavioral therapy” for a month now and my general impression is that, like rewriting the lives of revolutionary leaders to make them palatable to liberals and denaturing their core values in the process, DBT has completely corroded dialectics to make it “pragmatic” and serve neoliberal interests. For example the idea that there is a static reality which cannot be changed is metaphysical, not dialectical. To hell with “radical acceptance.” I am in favor of radical negation! The power of negativity can be an optimistic force for the becoming of Good!
I love your vision of human-centered therapy rooted in compassion and a holistic view of human becomings vis a vis the animalizing nature of The Beast as most of us here in MIA know him. Yea, I hold the conviction that psychiatry is an anti-Christ. Call an exorcist! (Keep posting wonderful articles which shed light upon darkness, that is. Your contributors are a special, secular priesthood of an extraordinary type.)
We need radical changes because desperate times call for deperate measures. Blessed are the one-way ticket holders on the peace train. No son will stop our choo choo train, to hell with televised visions and illuminatus sigils. (Playboy Carti wrote a song about me called Evil J0rdan.) All aboard.
https://youtu.be/crbFmpezO4A?si=WYlWni6FHJWYAkNP
https://youtu.be/Pca2l_2hDb8?si=CgNKns6bOI70pqcK
Report comment
I would still like to know what CREDIBLE body of scientific knowledge endows so-called mental health professionals with the unique skills, wisdom, and insight that supposedly give them the ability to properly analyze and make informed judgments on the soundness of their clients’ thinking, emotions, and behavior.
Whose totally subjective speculations can and should be considered an authoritative guide to “clinical” practice in the psy disciplines—Freud, Jung, Beck, Skinner, Janov, Hubbard, Reich, Lowen, Ellis, and countless other lesser lights?
Report comment
Why report on a PsiAN paid vanity survey. It was just an excuse to write an article extolling psychodynamic therapy without adding much to the conversation.
The top three endorsed expectations random people have of therapy is that it is:
“to share your thoughts and feelings without feeling judged or ashamed” (73%),
“to better understand yourself and the root of your issues” (67%), and
“to learn skills and coping strategies to manage your thoughts and emotions” (64%)
These things happen in more than psychodynamic psychotherapy with as much frequency, so I don’t see why this is evidence for public demand for psychodynamic work. I would also argue that learning skills/strategies is something that is expressly not done in psychodynamic psychotherapy. I also think the conflation of “understand yourself” and “root cause of your issues” into one statement obfuscates the differences between these concepts and is just a ploy to get more people to endorse this statement if they only agree with part of it, for the purpose of manufacturing evidence that psychodynamic psychotherapy is what people think therapy should be.
They claim “Respondents also endorsed the statement ‘therapy that explores the past is more effective because it gets to the root of the problem” (40%)’ because that is in their interest, despite also saying, “the public did not strongly endorse statements such as ‘the main goal of therapy is to feel better about yourself,’ (51%), to “find happiness, fulfillment, and purpose,’ (42%),” despite these being more endorsed than the root problem/past exploration. Again, this whole piece is just an excuse to write an article about how good psychodynamic therapy is (to support the livelihoods of psychodynamic therapists) regardless of whatever evidence they find.
They really do a bad job of reporting methodology (characteristic of psychodynamic therapists at this point). Please let me know if I am wrong, but it seems like this survey took a random market research approach with only main qualifier needing to be awareness of concept of psychotherapy exists to support mental health. Yet, they also ask questions like the kinds of therapies participants have engaged in and only report percentage of respondents, not the actual number, nor even a percentage of people who did not receive therapy. This is odd because having received therapy was not an inclusion factor to participate. So it is presumable that less (perhaps far less) than their total sample were able to answer this questions.
Even with this flaw, the finding that of people who did go to therapy (we don’t know how many of this random sample), 37% percent of people did not know what kind of therapy they were engaged in. To me this indicates a failure of informed consent processes at a base level.
There is more to this. But please don’t conceive of these obvious advocacy publications written and funded by an advocacy organization as anything but that. It is misleading to your readers, and perhaps shows the the uncritical biases here at MiA.
I will note my bias against the psychodynamic therapy for:
its long failure to produce rigorous effectiveness studies
failure to report on harms
pre-Nuremberg lack of consent processes
high risk of abuses
Its tight connection to Psychiatry in the US (Psychodynamic psychotherapy has remained more prevalent in psychiatry residency training despite less present or even marginalized in clinical psychology and other mental health professions)
personal experiences being coerced into such therapy that exacerbated the crises at hand and was then increasingly pathologized for leaving it.
Commodifying significant relationships is as much of a problem as drugging feelings. I wish MiA would stop reporting so uncritically on psychoanalytically derived therapies as they are also not part of this industry.
Report comment
Psychotherapy for me was like playing a game of Twister in the dark with therapists and psychiatrists who refused to turn on the lights.
Report comment
…and for the record, I was in “psychodynamic” therapy—not the fast-food types referred to in this article—meaning that first-hand experience taught me that peek-a-boo therapy is by no means an improvement.
Better to call it “The Hollow Pursuit”.
Report comment
“…it is time for therapists to reclaim the narrative and to speak clearly, ethically and compellingly about what therapy is for, and what it can become.”
WRONG. It’s time for people to discover how much better life can be without so-called “therapy”.
Report comment
Perhaps people should ask themselves: Why trust those trained to hold up a mirror of illness?
Report comment
Wanna get to the root of your problems? Ditch the therapy schtick and you’re halfway there.
Report comment
More food for thought:
Any field that defines you by your struggles instead of your strengths is a pile of shit.
Report comment
Any field that attempts to reduce the complexity of human thought, emotion, and behavior to wholly arbitrary checklists of “symptoms” is likewise a pile of excrement.
Report comment
Yes, indeed 🙂
Report comment