This was not, in fact, a fictional plotline, but reportage from the pretrial hearing of Mango heir Jonathan Andic, accused of murdering his father Isak, and whose therapist, Julia Lüderwaldt, faced questioning for her unconventional methods. Lüderwaldt had, at first, resisted police questioning, citing client confidentiality in line with therapeutic norms. When it transpired that Lüderwaldt, who described herself as a “prestigious doctor, psychologist and psychoanalyst”, appeared to lack formal registration in any of those fields — and therefore risked prosecution for misuse of protected titles — she changed her mind.

In Spain, as in Britain and the US, all manner of self-styled therapists and coaches proliferate on social media, building their brand on TikTok or Instagram and selling their one-to-one services to a parasocially captured audience. But Lüderwaldt wasn’t flogging life coaching or dodgy diagnoses to frazzled mums; she was high-end, her marketing limited to word of mouth among Spain’s ultra-high-net-worth. If she wasn’t a proper therapist, what was she?

From shows like White Lotus and Succession, we’re familiar with the shadowy hinterland of helpmeets and fixers that subsists around the powerful and rich. Masseurs, meditation coaches and sex workers are variously employed to meet needs that prove more existential than physiological: there is something about the condition of being unconstrained by material concerns that messes people up, and confidants can emerge in unexpected places. Not that this is just a TV fantasy. Cherie Blair’s personal trainer Carole Caplin became her stylist and wellness advisor too, purveying crystals and quantum healing. The exact methodology of the court advisor, whether it’s fashion, Freud or craniosacral release, doesn’t necessarily matter so much as their charisma and the dependence they can foster in their client base. Even Rasputin started out as a wandering healer.

The Rasputin figure is a timeless archetype. The history of ancient Rome is peppered with astrologers and ex-slaves who slide into key decision-making roles. Rasputin himself filled a vacant position with the Romanovs after his predecessor, the French mystic-turned-physician Maître Philippe, got expelled from Russia for practicing medicine without a license, just as Spain’s courts might eventually come for Lüderwaldt. The Romanovs wanted a metaphysical shortcut to a viable male heir, but they also needed to offload their deepest anxieties outside the enforced secrecy of the family. A faith healer treating hemophilia already knew too much, and could therefore be told more, and the relief of speaking freely is a force in its own right, placing the listener in a position of formidable power.

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Today, the confessional relationship is no longer part of the spiritual domain. Lüderwaldt’s self-ID into psychotherapy is specific to our materialist times: we see ourselves as rational creatures whose suffering can best be met by science, and we yearn for the magic-bullet framework that can help us fix it.

The problem is that most of the putative science of our inner life is bunk. Academic psychology has well-documented problems replicating findings. Freud’s claims about the invisible mechanisms of the mind are shrouded in pseudoscientific language but largely unfalsifiable. This can sometimes be convenient: the “death of the father” was only ever a metaphor for one’s individuation into adulthood, at least if they ask in court. Besides, this reading is, if anything, a more sober take than Freud’s own musings, which argued that the drive to kill the father was rooted in sexual jealousy of his command of the mother or the harem of women-in-general, depending on which Freud you’re reading.

Point to a wilder element of psychoanalytic theory, such as penis envy, and the refrain is generally that true psychoanalysis no longer takes it seriously, rather like proponents of a religion argue that you’re only looking at the problematic passages in their holy book and not the bits about peace and love. True, Lüderwaldt may have been an uncredentialed maverick. Yet the actual ideas that actual therapists advocate, like polyvagal theory, internal family systems or Bessel van der Kolk’s popular trauma narratives, are often pretty dubious too.

But humans are fallible creatures who like ego-validation even more than the sciencey vibes that prop it up: give us a story, any story, that absolves us of blame, or that, even better, makes us victim rather than offender in our interpersonal power games, and we’re captivated. The twin themes of Lüderwaldt’s most high-profile work seem to be family and money. Tennis star Arantxa Sánchez Vicario accused her family of mismanaging her earnings; Lüderwaldt reportedly intervened. The husband of a Spanish royal was convicted of embezzlement of public funds; Lüderwaldt helped the family adjust to the news. The backdrop of Jonathan Andic’s cliff-top confrontation was a disputed inheritance: a reasonably modest advance, and a charitable foundation that would have swallowed the remainder. Lüderwaldt reportedly pressured Isak Andic into giving his son a figure of €40 million.

We can only speculate whether Lüderwaldt’s genius involved reframing the ugly realities of familial money tussles into the language of inner conflict. Certainly, with the right therapeutic prodding, fighting over money can be turned into a tale of emotional betrayal. Your drive to manage your reputation in the midst of scandal is a trauma in which you, not the taxpayer, are the ultimate victim; your resentment over not being handed enough unearned wealth is a need for reparation, without which the primal wound of your father’s dominance will continue to fester.

The laundering of human greed and vanity into morally palatable tales of victimhood is therapy culture’s contribution to our times. We can’t lay all of this at Freud’s door. Much of it stems from the pay-to-play financial dynamic of the therapeutic relationship. Financial security stems from happy customers, and while therapists are supposed to swim upstream against the tendency to people-please, many don’t. The client holds the purse strings and, in return, the therapist shapes the client’s perception of their world. A strange thing about our current moment is that this practice of employing court flatterers is no longer limited to kings or magnates — it turns out we all want one in our lives.

If the inbuilt asymmetry of the therapeutic relationship lends itself to power games, the psychoanalytic tradition is a particularly rich repository of strategy for the master manipulator. Analysis claims that the patient cannot know his unconscious mind; he can only come to understand it, and what he really thinks, with the analyst’s interpretation. The core clinical concept of psychoanalysis, transference, requires the patient to redirect powerful unconscious feelings about his parents onto the analyst, who becomes an authority figure invoking intense emotions in the client.

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Once you accrue this kind of power, you have people over a barrel. Lüderwaldt is reported to have left former clients feeling guilty and tearful, totally dependent on her to make decisions. If, as reported, her tactics were to ramp up to more sessions with more family members over time, so that she was enmeshed within the family unit, her distorted version of psychoanalysis offered a route in. The family is the locus of your problems, and the analyst can take on that familial role to fix them.

In more religious times, Rasputin’s charisma was bolstered by his status as a holy man. The priesthood, whether within the official hierarchies of the Church or in the diffuse spiritual circles outside of it, wielded power. Some priests were good, but priests who were bad could do a lot of harm, unchecked by a credulous congregation.

Therapists are Rasputins, private priests-for-hire. Most of the therapeutic churches, or “modalities”, have rules to keep their congregations safe, such as boundaries that forbid therapists from seeking controlling stakes in family finances. Still, rogue priests are everywhere, including ones with certificates. The recovered memory and satanic ritual abuse movements were, for example, driven by impeccably credentialed, experienced practitioners who committed terrible harms to patients and their families.

What we should not do, therefore, is treat therapy with religious deference. Some therapists are bad, and some are good. Some therapeutic ideas, like listening to what people are saying without interruption, are sensible. Some, like the Oedipus complex, or orgone accumulators, or recovered memories, are really stupid.

Shows like The White Lotus were hits because they showed us that the rich and powerful are as naïve and fallible and weak as the rest of us. They invited us to laugh at their frailties. We felt very comfortable poking fun at Carole Caplin, the upstart with her woo-woo ideas about healing who somehow got an immensely powerful and well-educated QC to fall for her bullshit. We remain reticent when it comes to psychotherapy, though, even though it too is riven with laughable nonsense.

This is the 21st-century vision of play: it’s safe, organised, educational, always supervised by adults. And it might have killed off what we used to think of as play: kids running around whatever space they could find, improvising unpredictable games and creating social worlds unfathomable to their parents.

Children are far less free than they used to be. While 71% of Boomers and 80% of Gen X recall playing in the street as children, only 27% of children do today. And last week, MPs heard evidence in an inquiry into how the built environment restricts children’s independence, with charities warning that a lack of outdoor play is very bad for their development.

In urbanised environments, where land is at an all-time premium, finding a place to run around can be a challenge. One in eight children don’t have a garden and nearly 800 playgrounds have closed in the past decade. But this doesn’t account for the precipitous collapse of playing on the street, when roads are more regulated and safer than ever before. Nor does it acknowledge that there are still 16,000 playgrounds maintained by local authorities in the UK, and 27,000 parks. There must be some other factors at work.

Having a child is generally perceived as harder than it used to be. In three quarters of families in which the parents are together, both of them work. And childcare costs have risen precipitously. There has been an attendant boom in helicopter parenting, with couples more focused than ever on the details of their kids’ development. Their aim is to optimise their lives — and excise all bad externalities.

But this safetyist instinct does have blind spots. While parents might be grilled in A&E if they bring in their child with a minor injury from climbing a tree; nobody tells you off for parking your toddler on the iPad for half an hour that turns into half a day. If your kids are a bit pallid from spending more time online than outside, that’s accepted as normal. Safeguarding culture is obsessed with preventing tangible, acute injuries such as cuts and bruises, but the slower chronic harms that emerge over years are often ignored — even though we know, and lament, that children are increasingly less physically and mentally healthy.

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At the heart of this issue is whether children are free to exercise their instincts. Dutch cultural theorist Johan Huizinga saw play as primal: just like any other young animal, children have an intrinsic drive to play, and don’t need to be taught how to do it.  Huizinga defines play as an act of self-directed freedom. It can only really happen when children are left to their own devices, which requires parents to ignore them.

To modern helicopter parents, this can feel counterintuitive. We are increasingly uncomfortable about our children’s discomfort: the influence of safetyism can be seen in how we approach their emotional lives as well as their corporeal ones. Parents worry that boredom is bad — when actually, it is an important learning experience. It’s a transitional space in which the child realises that she needs to do something differently. She might then try to attract a parent’s attention. If she doesn’t get it, she gets fractious; if she is still ignored, she eventually finds something else to do. If we leave that novelty-seeking impulse to develop, it turns into creativity. It just needs time.

This is increasingly difficult, though, now that we all have distraction machines in the palms of our hands. Most adults won’t choose the disgruntlement of boredom over the abundance of synthetic novelties on offer online — which makes it hard to admonish a child for seeking the Xbox or the iPad rather than inventing their own forms of entertainment.

And it’s true that when play involves temporary social orders, it brings discomfort with it. Playing out in the street means muddling along with whoever else is out there; it means trying — and often failing — to assert one’s role in an emergent group, which might be big, and include kids who are taller and older and cleverer. When children play structured games, whether it’s hide and seek or a ball game or soldiers fighting in the trenches, they have to abide by the rules of engagement — and deal with losing.

In other words, play is a good warm-up for life. But, crucially, it doesn’t take place for material or real-world gain. The goals exist outside of the goals we ordinarily strive for, and they evaporate. Kids need to be emotionally committed enough to want to win, but not so invested that they kick off when they don’t. At a time when children spend years of their lives being examined and graded in school, there’s benefit in both learning to strive and learning to let go.

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True play also teaches kids how to deal with uncertainty. So argued the French sociologist Roger Caillois, who built on Huizinga’s theory, emphasising that play isn’t predetermined, but animated by chaos. Hence why play necessarily comes with risk. Now, children are far more likely to engage in a sort of pseudo-play, either in the form of online games, which are pipelines of reliable and predictable dopamine hits, or educational games, which are led by the parent or teacher rather than by children themselves, and where the goals are geared towards real-world pedagogical gain. Whereas Huizinga argued that play happens outside of ordinary life — and is therefore a kind of anarchy — pseudo-play conforms entirely to conventional structures, whether it’s the gaming-industrial complex or the lifestyle capitalism promoting Important Experiences.

The forest schools and educational toys and tasteful wooden games that sneakily give kids lessons about biodiversity or engineering or maths may be wholesome, even captivating, but they’re anything but self-organising. We see this in the adult world of play, too. A festival was once a break from normal social order — a temporary, wild otherworld. Now, it’s a luxurious curated experience. Whereas play, for Caillois, was “an occasion of pure waste: waste of time, energy, ingenuity, skill, and often of money”, now, everything has to be optimised. But what happens when we’re not allowed to be wasteful? When all our earliest memories are goal-oriented, outcome-focused, organised?

A therapist friend who works with students at a nearby high-performing university observes that they often arrive burnt out and depressed. He’ll ask them what is meaningful to them, what their vision of a better life would be. They’ll go silent, confused. Deciding that, surely, is his job? Their motivation for going to therapy isn’t to find meaning — it is the knowledge that you need to look after your mental health in order to be productive. His strategy is to be playful with them, which rattles them at first, but they soon soften into it. Their thinking relaxes, and they start to find new avenues out of their malaise.

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Play, then, is an essential part of growing up — and, later, of life. For Huizinga, play was a sign of the “mind breaking down the determinism of the cosmos”, of a person forging their own path. Hence why play is getting harder: the techno-capitalist society we currently inhabit militates against autonomy; if people are to be interchangeable units of labour in a bigger machine, they have to do as they’re told. And so it sets out clear performance indicators for us, a tick-list of achievements in our roles as children, parents, workers and social beings, from which deviation feels like failure.

If we lose autonomy, we tend to lose faith in ourselves. For parents, this can manifest as fear: what if my child is unhappy, what if they get hurt, what if I haven’t done enough for them? Letting go is the best way to point children towards the path to a fulfilling life. Providing space for them to play isn’t just about parks and gardens — it’s about knowing when to trust them to work things out for themselves, and to cope when things go wrong.

There is something dystopian about people competing for the attention of a famous podcast host to solve their most intimate problems. Hundreds of couples apply for a handful of opportunities to share their stories with Perel, along with her legion of listeners. Her 2006 bestselling guide to marital relations, Mating in Captivity, established her as TED-talking international authority on relationships. By the time Where Should We Begin? launched in 2017, Perel was listed in Oprah Winfrey’s SuperSoul 100 list of “spiritual luminaries”. Her podcast has been downloaded 50 million times since its launch.

It’s not hard to see why. As radical new ways of ordering relationships have proliferated, we no longer hold a set of principles for living in common. Liberalism’s marketplace of ideas has given rise to a marketplace of moralities: as free unbounded agents, we get to decide what is right for us. But when our bespoke moral stories clash with those adopted by other people in our lives, things get tricky: how do you resolve a conflict when you cannot agree on the rules that mediate it? Who do you turn to, to help you decide?

Enter Perel. She is fair, philosophical in encouraging a big-picture view of how to live well, and gently tough at making sure that the dynamic never falls into that of victim and aggressor. Nothing is sensationalised, and no one is demonised. She is something of a radical in the Anglosphere, where our one-strike-and-you’re-out attitude to cheating has remained intransigent even as non-traditional, non-monogamous relationships have become increasingly common. With divorce rates estimated at 42% in the UK and 45% in the US, and 27% of US adults estranged from a close family member, Perel’s more charitable approach to conflict might have merit.

She is also part of a trend. Therapists are increasingly becoming a kind of free-market priesthood, jockeying for the territory that actual priests once oversaw. With the decline of religion, we have lost any sense of a unifying story about how to live, without which we’re more likely to be miserable — as the mental health gains from being religious can attest. The claim of therapy is that it helps you shape the overarching narrative with which you make sense of the world, and how to live well in it. At best, going to one’s therapist is a substitute for confession, a time for honest reckoning; too often, though, clients see it as an indulgence, a means to divest one’s conscience of interpersonal responsibility. Once, we could have taken solace in doing the right thing by others; now, the feeling of solace comes first.

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Perel is too tough, and too professional, to let her clients avoid hard truths. But other therapy-as-content offers people that easy way out, dwelling purely on the solace. If Instagram laid the groundwork for the therapy influencer phenomenon, all pastel-coloured quotes and exhortations to set boundaries, TikTok took it to the next level. Therapists on the video-sharing site seem to see everything as a sign of trauma: transient negative emotions, feeling under-motivated, feeling over-motivated, feeling uncertain. Things that cause trauma include having to do homework, dead celebrities, and understocked supermarkets. If anyone suggests that these things might not actually cause trauma, TikTokers argue that they are “invalidating” that trauma — which, they insist, causes further trauma. The therapists who say things like this make their followers feel understood, offering sweet relief from the harsher offline world — and building their influence as they do.

An obvious concern of the influencer model of therapy is that anyone can set themselves up as a mental health expert, without any training or expertise. But most successful influencers on TikTok and Instagram are verifiably qualified therapists or psychologists. They’re careful with disclaimers too, reminding their audience that their content isn’t therapy.

But if it isn’t therapy, what is it? And who does it serve?

In The Genealogy of Morality, Nietzsche describes the emergence of a priesthood class that gains its influence by stirring up resentment. Until the priests come along, you may not even have understood that you were suffering. It is only when they point out injustices that the extent of your distress becomes apparent. They present you with a new, inverted moral code in which suffering is honourable and weakness is good, while the previous virtues of strength are abandoned.

The therapy influencers peddling trauma are straight out of the priesthood playbook. If the Nietzschean priesthood is all about radicalising the underclass against its oppressors, TikTok therapists have identified a vast new audience for this. Whipping up new flavours of trauma with every new social justice movement, they target a demographic who genuinely lack full autonomy, who have resented this since forever, and who spend a lot of time online: teens.

The #teentherapists’s USP is that they get it — your parents don’t listen, they don’t validate your experiences, they’re actively undermining you. The demands of school are too much right now. Setting consequences for your behaviour is abusive parenting, and it doesn’t work anyway. They’ll even shout at your mum for you. They argue that “reparenting” is required to fix all this trauma, setting themselves as the adults you really can trust.

Much of what these #teentherapists identify as abusive behaviour looks alarmingly like differences in opinion in how to navigate the world, or jarring communication styles. The information they’re sharing is bitesize, in videos that aren’t usually longer than a couple of minutes. It’s also general: whereas Perel offers insight into a specific relationship dynamic or individual psyche, TiKTok therapists are presenting universal “life lessons”. The brevity of the messaging and its attempt at catch-all appeal does little to help its audience discern abuse from ordinary conflict. There’s also something uncomfortable about adults cultivating mass parasocial relationships with kids, especially when the implication is that these distant adults are better authorities than those who are present in a teenager’s life lives.

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The TikTok therapists have an appealing moral sales pitch — they can reach out to a massive audience who would otherwise have been ignored. The app is more accessible than therapy. But in order to get their voices heard, therapists have to actively seek followers. If a TikTok influencer takes a strong line, viewers feel heard and vindicated, they get to blame someone else, and they want more of the same kind of validation. TikTok therapists get validation, too, from follower counts, and the book deal that might accompany them. They might even get to be the new Esther Perel.

But Perel isn’t speaking to you; she’s speaking to the couples in her session. Where most therapy-as-content cares little for the public good — it tells stories about our inner lives that can only atomise us further — Perel focuses on building, rather than destroying, social relations. Her branch of therapy is closer to genuine spirituality than the TikToker’s: the sociologist Émile Durkheim saw religion as a force for ordering interpersonal relationships, creating meaning and bringing people together to communicate and affirm shared values. It’s a version of spirituality that only works when it works in common, and you can’t achieve that in a me-centric universe.

Then again, the marketplace of meaning isn’t a uniquely postmodern phenomenon. The decline of the traditions of the Roman republic brought in weird new religions, which were mixed and matched to suit people’s temperament and station, just as elements of spirituality are today. Individualist spiritualism is nothing new, either: William James wrote about the cheesy affirmations of wellness-adjacent New Thought at the turn of the 20th century.

What is new is the impact of technology. The internet gives would-be priests access to souls worldwide, and allows them to repackage their advice into compelling, publicly-available content. The reality TV show Couples Therapy has had 50 million viewers, for instance. While Perel’s episodes conceal the identity of their subjects, Couples Therapy has not only real names but faces. A misanthrope might wonder whether that accounts in part for its wild success — there’s nothing like watching a real relationship melt down in real time. We watch Love Island for the drama of hot 20-somethings cycling through new relationships. How different is it to watch a 30-something couple conclude on TV that this is probably the end, skilfully assisted by a therapist?

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Perhaps it’s about how the therapy-as-content is presented. If it exists only as emotional pornography to feed our outrage, resentment, or lust for drama, there’s nothing very therapeutic going on. When it gives us the opportunity to think expansively about what sacrifice, loyalty or trade-offs mean in our interactions with one another, then it carries both personal and social benefits.

The way those stories are packaged and sold inevitably shapes the way we use them in the wild. Create shorts for kids that introduce a layer of conflict to ordinary hardships, and they’ll probably end up more lost and distressed. Edit a day of footage showing couples bickering by the poolside into a half-hour show of shallow emotions, and you’re arguably complicit in manipulating them for malign ends. Carefully stitch together real-life therapy sessions to represent a couple’s deepest challenges, with their informed consent, as Couples Therapy does, and you’ll have a largely thoughtful audience who, though titillated, are also inclined to care about the interpersonal conflict presented, and its broader social implications.

Likewise, Where Shall We Begin? avoids the hyperinflated trauma, lurid revelations and psychobabble that get the attention on TikTok or television, instead teasing out nuance and deep understanding from its subjects. Like a good priest, Perel offers her flock pastoral care, even when she is saying things it’s hard to hear. Perel’s clients are parables for her congregation. Every session, focused on one interpersonal relationship, poses big-question questions: about what it means to be a man, or married, or loyal. Each encourages us, therefore, to think a little harder about the principles for which we no longer have a blueprint.

REBT is characterised by a kind of rugged psychic individualism. In this view, if you hope to be psychologically fixed by relying on others, if you seek healing from interpersonal woo-woo like transference, you’ve already made a key philosophical error. You’ve outsourced your agency. And that’s before getting into the most eccentric elements of psychoanalytic theory — penis envy, the Oedipus complex, Melanie Klein’s baffling idea of the bad breast as persecutory object. To read Freud is to grit one’s teeth at the relentless dogmatism of his prose, the certainty with which assumptions that look absurd in the context of observable reality somehow grew legs and ran for decades. If you are looking for relief from mental distress, is it wise to procure it from people who believe in resentment-drenched theories that could only ever make sense to the pathologically horny and disturbed?

More generously understood, psychoanalysis is based on the idea that mental distress tends to arise from unconscious inner conflicts, and that past experiences — especially those of early childhood — exert a long-term effect on our thoughts, feelings and actions. The analyst assists the patient in exploring the depths of their mind, unearthing hidden meanings. Change happens by means of the therapeutic relationship, with the patient unconsciously acting out past conflicts. The process can take years.

Albert Ellis, the originator of REBT, was a psychoanalysis refusenik, as was Aaron Beck, the father of CBT as we know it today. Their early careers were largely an accident of history: both happened to train in clinical practice in the post-war era, when psychoanalysis was dominant. Both soon observed inconsistencies between the theoretical claims of how analysis worked and their own observations of patients. Beck noticed that negative views of the self, the world and the future characterised depressive episodes in patients, rather than the repressed feelings that Freud held to be their cause. The psychoanalytic process was only supposed to work if you saw the patients daily, maintaining the relational magic, but Ellis noted that his patients who only came in once a week did just as well, and that they did even better when he ditched the psychoanalytic theory and talked to them about philosophy instead.

What emerged from this was cognitive behavioural therapy. Rather than getting stuck into the past, it operated in the here and now, looking for the habits of thought and behaviour that maintain our distress, and finding ways of thinking and behaving that might work better. The therapist’s role was not as ersatz parent or interpreter, but as Socratic teacher, helping guide the patient’s reasoning to more pragmatic ends. This seems to have worked well: in the English-speaking world, the dominance of CBT makes Freud look more like a kooky curiosity in the history of ideas than the father of psychology.

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The ideological descendants of Freud have strong feelings about this. They’re not all psychoanalysts: there’s a genealogy of therapeutic styles that see human distress as the product of relational problems, from maternal attachment to structural oppression. They tend to see the solution as lying in the deepest layers of the self. Another thing they often have in common is really, really hating CBT.

The arguments vary. Psychodynamic psychologist Jonathan Shedler has suggested that its evidence base for CBT is skewed by selective reporting. Its heavy reliance on manuals, which therapist Nancy McWilliams criticises as rigid and simplistic, leads it to be mistakenly thought of as scientific. By focusing on the individual locus of control, CBT is a tool of neoliberalism, ignoring the systemic inequalities that shape people, telling us to grit our teeth and smile rather than try to change the world. For Jungian psychotherapist Paul Atkinson, CBT mostly serves industry, rather than the people it’s supposed to treat; it’s designed to make you a better cog in the machine. Since 2008, it has been provided for free by the Improving Access to Psychological Therapies (IAPT) programme, conceived by New Labour’s “happiness czar” Richard Layard, to improve economic productivity by way of public wellbeing. As a public investment, CBT was a good one: it is short-term, taking as few as six sessions to complete in straightforward cases, and therefore cheap. It is also highly structured, gathering its own data via regular symptom inventories, meaning it could be accountable to the public purse. Choosing CBT was following the science.

This infuriated CBT’s detractors, provoking a backlash against IAPT and CBT in general. Doubts have been raised over whether IAPT data supports the impressive results it claims; studies of CBT’s efficacy elsewhere have found it to fall over time, with one finding it no more effective than its nemesis. Given that it’s being offered for free to anyone who wants it, if CBT worked, you’d expect things to be going pretty well by now. Instead, we are less happy than we have ever been, with the ONS finding the UK prevalence of moderate or severe depressive symptoms at 21%. If, as the accusers declare, CBT isn’t really therapy but a coercive lever to make people economically productive, it’s not working: record numbers are out of work due to mental ill-health.

Each era brings its own problems. In Beck and Ellis’s time, sexuality was repressed in favour of propriety, which fed depression. In the 21st century, our wellbeing has been eviscerated by technology; the impact of the internet and smartphones is well-documented. Relationships, as we used to understand them, have collapsed. The world of work has changed: there are fewer casual, pleasurable digressions between colleagues; work is increasingly seen as something that happens in isolation, rather than in concert with people you care about. If the online world turns out to have rewired our attention, this may undermine our ability to maintain the cognitive control that allows the mechanics of CBT to happen.

Economics plays its part, too. Even before inflation and housing shortages piled on extra pressures, it was hard for a family to keep a roof over its head without two adults working full-time, which impacts time spent with loved ones. You can blame this on the capitalist pursuit of profit, or the creep of technological slavery, but the outcome is the same either way. We’re swimming in material goods, and relationally impoverished. This is where the psychoanalysts might have a point. Even if cognitive-behavioural therapists can train our thoughts, downplaying the influence of the external world on our wellbeing is unwise. Psychological studies are in agreement: the quality and quantity of our relationships strongly predict our wellbeing.

But there’s something perverse about the very idea of therapy when we think about it, as the psychoanalysts do, in the terms of a relationship. We have always spent money on the services of soothsayers, acupuncturists or hairdressers, but those transactions weren’t intentionally about paying for human contact. We have also always exchanged money for sex, though it has usually been social taboo. Now we pay similar prices for the more basic intercourse of being listened to. We don’t trust people who sell sexual affection, because that affection lasts only while they’re paid, but we place uncritical confidence in those who sell us empathy.

CBT may not be the panacea it was hoped to be, but psychoanalysts accusing it of neoliberalism are being hypocritical. Selling committed, long-term relationships looks a lot like commodifying humanity. And if state-funded therapy threatens your livelihood, you’re more likely to get cross about it.

Beck described the therapeutic relationship as necessary but not sufficient for change, which comes, first and foremost, from the patient methodically practising new habits of action and mind. By contrast, the labyrinthine doctrines and relational focus of psychoanalysis make it easier to abandon agency: you can hand over your wellbeing to someone with a parental-style command of what is really going on in your head, who can give your world meaning and keep you feeling safe. It’s more comfortable, at least in the short term, to be told that our problems came from others, but it carries interpersonal risks. Being told we’re victims of fate tends to make us resentful. If you’re feeling low and you’re told that the reason is probably a failure on your mother’s part, your attitude to relationships probably won’t improve. The same is true if you’re feeling bruised from a tricky break-up and are told that you’ve been traumatised.

CBT is, in some sense, classically liberal, in that it sees the individual as having autonomy over one’s own mind. It’s harder to pin down a single position for its detractors. A relational view of the world — especially one where attachment to the mother dictates later wellbeing — is fundamentally conservative. Current discourse around attachment and trauma, rooted in socio-economic forces, is mostly Leftist in character. The philosophies underlying therapeutic approaches should, in theory, have a profound impact on patient outcomes. But this doesn’t happen.

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Is liberal society making us ill?

By Gurwinder Bhogal

Psychological studies find that there’s remarkably little difference in outcome between wildly different therapeutic styles. This is known as the Dodo-bird effect, from the famous scene in Alice in Wonderland where all must have prizes. The stories we tell about our minds may have social consequences, depending on what or whom we find accountable when things go wrong, but they don’t make much difference to therapy itself. Individual studies of this or that approach will continue to make grand claims of their power. Other studies will erode them. But therapy’s value seems to stem from sitting in a room being listened to by someone we like. In which case, can’t we replicate this experience with friends or relatives in our lives?

What we can say with certainty is that in the decades since we normalised paying to be listened to, we haven’t become any happier. We know, too, that we do best when our lives are rich with relationships and meaning. Maybe it was always a stretch to think that these things could be bought, or provided by the state. Internecine squabbles between opposing forms of therapy might disguise a conclusion that looks bad for all of them. We don’t need shrinks or ever-growing datasets to work out if we’re okay: we’ll know things are looking up when we stop employing people to listen to us talk.