A therapist fact check of Bad Therapy: Why the Kids Aren’t Growing Up

Front cover of Bad Therapy: Why the kids aren't growing up by Abigail ShrierAs a licensed therapist, I am not the intended audience for Bad Therapy: Why the Kids Aren’t Growing Up. It’s written for those who are skeptical of mental health care and even mental health terminology directed at kids. It casts therapists and teachers as condescending elites who generally view parents as obstacles to children’s thriving.

I’ll credit author Abigail Shrier for this: I found myself agreeing more than I expected to. She identifies some potentially problematic trends in mental health care, criticizes some ways the language of mental health (and trauma in particular) has become culturally ingrained, and ultimately encourages anxious parents to chill out and let their kids’ childhood unfold. My wife and I are both licensed family therapists, and she works with kids, so we spend a lot of time discussing these very issues — and often land where Shrier does.

But in Bad Therapy, Shrier too often exaggerates the research she relies on, makes sweeping claims without support, and makes questionable leaps of logic. There are legitimate arguments to be made here, and I spent a lot of time puzzled at why Shrier didn’t seem to be trying all that hard to make them.

What is Bad Therapy about?

It takes some time for the real target of Bad Therapy to emerge. It isn’t therapists like me, despite Shrier’s evident disdain for the profession. And it isn’t schools, although the book spends a lot of time demonizing social-emotional learning. It’s parenting — more specifically, a caricature of anxious and intrusive upper-middle-class parenting. Parents in this mold would rather get professional diagnoses for children (and then let the diagnostic label become the child’s identity) than allow the children to suffer any kind of hardship or distress that they would need to work through on their own. That this is a caricature is most evident whenever Shrier gives mocking examples: Children “gently raised in Brentwood and Park Slope and Lincoln Park.” Hypothetical kids named Harper and Kennedy whose parents address misbehavior with deep breaths.

Who is Bad Therapy for?

Shrier doesn’t seem to be trying to change any minds here. Instead, Bad Therapy reads like she’s preaching to the choir, selling parental-rights activists on the notion that they shouldn’t be content attacking the teachers and librarians at their kids’ schools. They should go after the school’s counselors, too. She name-checks Joe Rogan multiple times, and interviews Jordan Peterson, the latter in service of a weird and ineffective tangent about school mental health surveys.

Slate‘s review — which basically shrugs off the whole book with a Yeah, parenting is hard, you do you — hits the nail on the head:

Shrier, no idiot, surely knows that several of her arguments—especially the ones about how we overreact to normal childhood setbacks, restricting kids from independence in the real world while giving them far too much digital autonomy—resonate with liberal parents too. But she has no real interest in engaging with those readers.

Anna Nordberg, “Who’s making the kids cry? Abigail Shrier’s Bad Therapy, reviewed.” Slate, Feb 27, 2024

You might then reasonably ask, why fact-check this book at all? Well, I’ve been hearing a lot of discussion about the book from students and colleagues. Many of them are hearing about it from parents. So my discussion here is meant for my fellow clinicians (and those studying to become therapists). I hope to take some steam out of both corners: The book is neither as wrong as some therapists might dismiss it as being, nor as right as some therapists may fear (and some clients may believe) it to be.

There is a lot to question in Bad Therapy. What follows shouldn’t be seen as a comprehensive fact-check. Instead, I’ll address just a handful of what therapists may consider to be the most troubling assertions.

What’s right in Bad Therapy

Much of what Shrier describes in Bad Therapy is reasonable criticism, with basis in fact:

  • Despite our best efforts, preventive mental health care isn’t really a thing.
  • Going to therapy in the absence of symptoms can lead otherwise relatively well-functioning people to ruminate on negative aspects of their lives.
  • The same can be said of pushing relatively well-functioning children to focus in school on their family and emotional stressors.
  • In a minority of cases, therapy is not just ineffective but actively harmful, leaving clients worse off than they were initially.
  • Sometimes individuals dealing with trauma are better served by not talking about it.
  • Despite their good intentions, therapists sometimes nudge (or shove) clients toward decisions that may not be in the client’s best interests, like cutting off family relationships.

Each of these is a legitimate concern, ripe for scholarly exposure. Mental health professionals have a fair amount of history of getting ahead of ourselves in accepting a trend in mental health care as if it were truth. One of Shrier’s most powerful therapy-related arguments is that it’s an uncomfortably short walk from the now-discredited notion of “recovered memories” to the widely accepted, if scientifically questionable, idea of traumatic experiences living in “implicit memory.” The fact that Bessel van der Kolk has championed both sets of ideas only makes them look more similar.

But Shrier also spends a lot of time missing the mark, in ways that range from unfortunate to misleading. Here are a few examples.

Negative impacts of therapy

While therapy has negative effects in about 10% of cases, according to well-established and replicated research, she cites a higher number that came from a single study of a single form of treatment. It’s an odd choice, considering that the markedly stronger science still supports her point.

Restorative justice in schools

Shrier cites a RAND study of restorative justice practices in schools, and says that the schools that adopted restorative justice “fell apart.” But that’s not what the study she cites says.

It’s correct that the schools didn’t see all of the expected benefits of restorative justice. But the schools didn’t crumble. The results were the kind of mixed bag of outcomes common in implementation studies. Suspension rates decreased, and disparities in suspensions decreased as well. At the same time, arrests increased. Academic outcomes were worse in grades 6-8 and unchanged at other levels.

Critical Incident Stress Debriefing

Shrier criticizes the world of therapy for critical incident stress debriefing, an older form of trauma therapy that some studies showed was more likely to hurt than help the people who went through it. She fails to mention that CISD isn’t done today precisely because of those studies. The scientific process worked the way that it should, and those who experience trauma are now better off as a result.

Criticizing therapists for having once used a form of therapy that was later debunked is sort of like criticizing physicians for all those lobotomies. It’s not wrong, and it even can work well as an example of how health care practices can move from theory to common practice without first gathering necessary evidence of effectiveness. But Shrier doesn’t contextualize it that way. As a result, it feels out of place in what otherwise attempts to be a criticism of the current state of mental health care for children.

Social-Emotional Learning in Schools

Shrier makes some of her strongest and most detailed arguments against the use of Social-Emotional Learning in schools. SEL suggests that teachers should integrate mental health awareness, and active discussion of children’s immediate emotional states, into all levels and subjects of schooling. If not implemented thoughtfully, this can place teachers in quasi-therapist roles without the necessary mental health training, and Shrier offers powerful anecdotes of how this can go wrong.

She and the experts she interviewed argue that even when SEL is implemented as intended, it can lead to a state orientation in children, where they focus on the struggles, pressures, and frustrations of their lives. What most kids really need in school is a task orientation, Shrier argues, where kids put aside those concerns and focus on the tasks in front of them.

It’s an interesting argument, and it resonates on a logical level. Why should kids need to talk about their feelings in math class? But Shrier doesn’t produce evidence here, just opinions, and there is a robust body of evidence supporting SEL when implemented well. A government-funded report examined hundreds of studies of SEL and concluded that well-implemented SEL reduces conduct problems and improves average achievement test scores.

It would be worth considering whether SEL improves circumstances for some students at the expense of others. Perhaps SEL’s benefits are concentrated among those children suffering the most, and the accommodations of SEL are stifling those children who would otherwise be excelling. But Shrier doesn’t even attempt that more nuanced argument.

Citation needed

There are a number of sweeping statements that are delivered and then simply walked away from. Of course, it’s perfectly reasonable to offer an opinion based on one’s own judgment or summary of underlying facts. But it’s another thing to offer an opinion without any apparent justification or factual basis, and then to treat that opinion as a fact for other purposes.

Shrier offhandedly describes mental health care as “remarkably under regulated,” without further explanation or referencing. I suspect that few therapists, who run through a gauntlet of nonsensical requirements just to get licensed, would agree.

She later suggests that most child therapists “ought to be fired on the spot” (um, no; while some child treatment is unnecessary, therapy for child behavior problems works quite well) and that parents should “take all the stuff you’re doing for your kids […] and toss about a third of it out.” Even on the parenting pieces I strongly agreed with in principle, I kept wondering, Where is she getting this from?

Insulation from criticism

After having read through the whole thing, I keep going back to the disclaimer at the beginning of Bad Therapy. In it, Shrier separates those children with significant mental health needs from those without such needs, and attempts to clarify that the book is about the latter group, not the former.

So if your child’s suffering is truly debilitating, ignore the rest of the book. She doesn’t mean your kid.

That disclaimer makes the whole exercise of Bad Therapy the kind of unfalsifiable tautology that, within the book, she routinely criticizes. Therapy is only actually bad, apparently, when it’s not really needed.

Should therapists read Bad Therapy?

Bad Therapy provides an interesting counterpoint to some of the trends in the field that we too often go along with simply because they’re popular, mistaking that popularity for well-established benefit. It gives voice to those who are skeptical of the notion that every child is traumatized, and therefore every child needs therapy or something similar. It reminds us that the field has fallen victim to harmful trends too often in the past, and that despite our good intentions, diagnosing a child with mental illness can cause a variety of harms to that child’s long-term well-being.

But Shrier seems content to be a firebrand. Her arguments, even the ones I agree with, often don’t really land. Her audience will cheer her on just the same.