Psychologist: money down the drain for some, a miracle for others

No one measures whether a psychologist gets it right: the same therapy cures or is a scam

A middle-aged man, with a stable job and a life that works, strings together periods of feeling low without anything breaking. He goes to a psychologist. He comes out, session after session, with the impression of not having moved an inch. And yet, in the same conversation, other accounts describe the opposite: a therapy that ordered his head and changed his life. Both verdicts coexist and there's no way to know which is the right one, because here no one publishes a results counter.

The starting point is a middle-aged heterosenshetero man who describes episodes of existential emptiness, "dysthymia" in his own words, without loss of control or severity. A functional person who, in his dark times, starts philosophizing about life. He has been to consultations several times. He has always been attended by women, and there is one of the keys to his story: emotionally undressing before a professional in her twenties or early thirties seems almost ridiculous to him. With a 60-year-old therapist, he says, he felt much more comfortable. His conclusion is blunt: "personally, it has seemed like money down the drain." And he adds the obligatory tag: it is not a criticism of the profession.

A discipline without a scoreboard: when the fault is always the patient's

The most repeated argument among critics is the absence of measurement. A lawyer loses or wins; a doctor gets it right or wrong with a blood test in front of him. In therapy there is nothing measurable, maintains one of the harshest positions: if the result doesn't come, it can always be attributed to the patient not doing their part. That structure, it is argued, leaves the professional covered against any failure and the client without a way to complain.

Against that, the classic defense of the profession appeals to the mirror. Those who have experienced it that way describe it as someone who doesn't know you at all, doesn't judge you, and reflects an image of yourself that you hadn't seen. "It's like having a mirror of yourself that helps you realize patterns and ways of functioning that you weren't aware of," summarizes a testimony that does consider therapy to have worked for them. The difference between both sides is not in the method: it's in what each expected to find.

Twenty minutes in public healthcare versus sessions of almost an hour

The public route takes much of the criticism. There are accounts of 20-minute consultations where the advice received was along the lines of "if you're sad, smile." There are also those who went to an association and found a professional who, according to their version, ended up worse than the patient. The contrast comes with the therapist who did help: sessions of about an hour, with a frequency of every fifteen days during the first two months.

And even so, money guarantees nothing. A single account accumulates three therapists: the first two, time and bill without result; the third, an older professional, "very expensive," described as a miracle worker. Another case told from a family perspective ends worse: a man in drug rehabilitation who came out of each session crying and feeling low, until his family decided to cut off the therapy. The finding is not whether psychology works or not, but that finding the right professional looks too much like a lottery.

Pills before conversation

In the psychiatric field, the public's verdict is even harsher. A recent experience in public healthcare describes a consultation in which, according to the account, the only result was a prescription: anesthetizing the patient so they don't think. The underlying accusation is of a system that attacks symptoms instead of causes and turns care into a quick procedure. The reply from the other side is that many people come asking for exactly that: a pill that restores balance without going through the work of looking inside.

The episode that best summarizes that frustration is not about psychology, but insomnia. A chronic patient goes to the neurologist and receives the usual prescription: warm bath, less caffeine, a glass of milk. His response, now desperate, is the obvious question: if even with the drug he can't sleep, what is warm milk supposed to fix? It's the same reproach that runs through mental health consultations: textbook solutions for problems that stopped being textbook years ago.

Running, meditating, or reading philosophy: the plan B of those who heal themselves

Outside the consultation, the range of alternatives that appears is wide and unorthodox. Exercise, sports, meditation, deep reading of philosophy, a leave of absence to rest and break with the source of stress. There are also those who elevate the problem to a more ambitious thesis: dissatisfaction is the price of living in a country where eating is already guaranteed, and once needs are covered, the brain invents the problems it has left over. For those who hold this, therapy fixes nothing because the ailment is not clinical, but existential.

There lies the knot: some patients ask for relief and others ask for meaning, and it's not always the same consultation that serves for one or the other. Some come out with a mirror, some come out with a prescription, and some come out convinced that the mirror was a fogged-up glass.

An uncomfortable question remains on the table: if the main success factor seems to be the fit between patient and therapist, does it make sense to keep selling therapy as a standardized procedure, or should we admit that it looks more like finding a partner than taking an antibiotic?