Prince Harry and the trouble with therapy
He is living proof that oversharing and introspection can make your problems a whole lot worse.
Following the publication of Prince Harry’s colourful memoir, Spare, we might wonder whether he is the first person in history to kiss-and-tell on himself. The Duke’s well-publicised desire for privacy does not sit easily with his book’s many intimate confessions, some of them tragic, many of them tawdry. Like flies on a sun-kissed wall at one of his Montecito therapy sessions, millions of readers worldwide have now basked in Harry’s detailed revelations. He has long advocated talking positively about mental health. But now his revelations are raising many questions about the success, or otherwise, of psychotherapy.
Media medic Dr Max Pemberton worries the prince is ‘a poor advert for the many benefits of therapy’. Others have criticised the way in which Harry ‘catastrophises’ every minor ill. Even senior royals have weighed in on the debate. At an engagement in Liverpool, only a few days after Spare hit the shelves, Kate Middleton suggested pointedly that ‘talking therapies don’t work for some’.
As one of the few health researchers who has dared to put psychotherapy itself on to the couch, I welcome this surge of scepticism – belated though it is. That now-infamous sibling skirmish and dog-bowl breakage detailed in Spare, followed by Harry’s dash to speed-dial his therapist, serves as a valuable warning of psychotherapy’s shortcomings.
It is crucial to emphasise that psychotherapy is not all bad. Harry often says that talking cures can be highly effective, and research indicates he is right. Unlike popping pills to assuage depression, therapy can prevent further mental-health breakdowns. But while there are proven benefits to psychotherapy, its potential for nasty side effects has scarcely been examined.
In the UK, psychotherapy is still not statutorily regulated. That means it is legal for anyone in Britain to set themselves up as a therapist and declare their healing potential. This lack of professional regulation can mean that people experiencing mental-health problems, when at their most vulnerable, may be subjected to harmful practices, dispensed by unregistered practitioners.
What’s more, while therapists always encourage self-exploration among their clients, they rarely examine the weak spots 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 following long-term therapy.
Meanwhile, therapists charge by the hour, not the outcome. So if a client’s mental health takes a downturn during sessions, they can always be encouraged to keep coming and do more work 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 the vaguest of impressions about what goes on in sessions and why. Unfortunately, there is a very good explanation for this: many therapists themselves have only a tenuous grasp of how therapy works.
Whatever the version of treatment therapists practise – some will talk about ‘cognitive restructuring’, others will reference Freud’s ‘phallic’ stages of development (in Spare Harry refers to his ‘todger’ more than 15 times) – their jargon tends towards the pseudo-scientific. Often, this fails to take into account cutting-edge psychology and neuroscience, as most therapists prefer theorising. I have first-hand experience of this myself. A therapist once suggested I seek out my ‘inner child’. Suspecting there isn’t a youthful homunculus living in my brain, I never returned.
Perhaps unwittingly, Harry’s mental-health activism has highlighted the prevalence today of many curious-looking cures. In a televised therapy session in 2021, Harry was shown tapping his chest to channel his traumas. He was demonstrating ‘eye-movement desensitisation reprocessing’ (EMDR) therapy. You might be surprised to learn how often this practice is recommended.
Serious scientific debate rages about the relative effectiveness of the hundreds of different kinds of therapy. But some research shows that the type of therapy itself might be less important than the quality of the practitioner. A large body of evidence demonstrates that positive outcomes are associated with a therapist’s empathy, clients’ expectations and a good working relationship between the two people in the room – regardless of the arcane techniques the therapist employs. What may matter most is the patient’s belief in the therapy, and their bond with the therapist. In the era of ‘sharing’, it would be useful for paying clients, and broken healthcare systems, to know this stuff.
So while it is true that therapy can be highly effective, it undoubtedly suffers from a fragile relationship with the facts.
Worse still for lovers of the truth, restoring clients to good mental health often requires you to slip on the rose-tinted spectacles. People who are mildly depressed (but not severely) tend to exhibit a higher degree of realism about their lives – a phenomenon aptly known as ‘depressive realism’. On the flipside, psychologists have long-recognised that Pollyanna-ish illusions – such as an exaggerated view of one’s popularity, intelligence, good looks or sense of control over events – are associated with positive wellbeing.
Indeed, achieving positive mental health, which is the goal of therapy, may inevitably mean our personal relationship with the facts gets slightly skewed. Put another way, therapy is fertile soil for tilling self-serving ‘truths’ – personal narratives that elevate the client from helpless victim to hero protagonist. Might the Duke of Sussex have benefited from such fictional salves? I couldn’t possibly say.
Charlotte Blease is a research affiliate in digital psychiatry at Harvard Medical School and Uppsala University, Sweden. Follow her on Twitter: @crblease
Picture by: YouTube / Inside Edition.
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