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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Why CBT won't set you free

By Nina Lyon

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.

How does this apply, you might ask, to a 13-year-old girl who’s being bullied at school, turning to ChatGPT to ask why it’s always her who’s the victim. Or a 17-year-old boy sharing, for the first time, that he feels so empty. Or a middle-aged man, in a messy divorce, who’s terrified he’ll lose contact with his children? The person typing their deepest feelings into an empty search box may well feel frightened. But the large-language model (LLM) mimicking the tone of a concerned therapist cannot feel fear. It cannot feel anything at all — and that is why it is not a therapist. It is also why, as a psychodynamic psychotherapist, I know that AI could never do my job.

But I am worried about the people who are turning to bots for some simulacrum of therapy, taken in by the seductive gratification and convenience that they offer. Indeed, this is how these LLMs are being sold to us. Last year, Mark Zuckerberg announced in all seriousness that free therapy sessions with Meta’s AI could help “solve” the loneliness epidemic. You can see why it might appeal; it’s available wherever, whenever, and offers immediate responses that are designed to flatter rather than challenge, to tell you exactly what you want to hear and then discreetly disappear when your needs have been satisfied, with no wants of its own.

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With the NHS drowning in long waiting lists for mental health services, and deeper cuts to talking therapies coming that will make it even harder for vulnerable people to get the treatment they need, it is hardly surprising that millions are now turning to AI for therapy. Indeed, along with helping students to cheat on their coursework, providing emotional support and validation might just be AI’s most successful consumer application.

One recent study showed that one-in-four 13- to 17-year-olds in England and Wales are asking AI chatbots for mental health advice. Another study found the bots endorsed behaviors including bringing a knife to school, pursuing a relationship between a minor and adult, and suicide. It’s not just young people who are at risk: one recent study showed more than a third of adults have used an AI chatbot for mental health support.

I had never tried to use ChatGPT before writing this article. I was disturbed by how easy it is to use. I told it a made-up but common-enough scenario: that I was feeling low because my partner doesn’t reply to my texts while he’s at work, and that this leaves me feeling unloved and abandoned. Its responses were like a shallow mimicry of friendship: “If you want to share, I’m here to listen”. There was a tone of hollow empathy and a pathetic pretense at naming my feelings, which, if I didn’t have any experience of real therapy, I might have misunderstood as helpful. The bot’s responses were obsequious and saccharine: “I’m sorry you’re feeling that way… Wanting to be understood by your partner is a very normal need [heart emoji]”.

It also offered advice, even though the bot is “not intended to give advice”. It was the kind of inane blather that you might read in a pre-teen magazine. It’s not that the advice was bad, necessarily — it’s that it was superficial, generalized and obvious. As Bion would have put it, “one wonders why they are bothering to find out what everyone knows.”

The deeper in I went, the more I felt lost in some bizarre, Black Mirror-esque hologram relationship. “You don’t have to handle these feelings alone. I’m here to talk it through with you.” But I am literally alone! There is no other “I” there with me, just words on a screen.

As with all tech products, I could also smell it was designed to keep my attention trained upon it. I could recognize the tug of the potentially never-ending emotional stroking with which ChatGPT was attempting to seduce me with. Again — perhaps because I know what real therapy is — it left me cold.

But what is even more disturbing about this product is the way it is being sold as a solution to the teen mental health crisis that it is also blamed for. It’s like taking a deep swig from the bottle labeled “antidote”, only to realize, too late, that it is the same as the poison you’d been just drinking.

I chose this particular scenario — a partner not responding to text messages — because it’s something that patients often bring up in sessions. When they do, I see it as an opportunity to explore their feelings of abandonment. It’s one of the benefits of what therapists call the psychodynamic frame — and it’s part of the reason we offer 50-minute sessions at the same time each week, in the same place, with minimal interactions in between, rather than being available 24/7 at the swipe of a screen. It means we can offer a contained setting in which to explore and digest, in a real and meaningful way, whatever frustration, disappointment, loneliness and neglect a patient might feel about their therapist not being available in the way they want them to be.

These feelings have deep roots; we all experienced this as infants with our parents in some way. In therapy, the patient can then develop the capacity to understand this internal experience, and that is vital for when they feel something similar with all the other people who aren’t available 24/7, at the swipe of the screen.

When I put this to ChatGPT, it acknowledged that my partner might not have replied because he was, in fact, busy working. But instead of helping me tolerate this dynamic, it was delivering the kind of instantaneous responses that I demanded from my partner. A text box flashed up, part-way through the exchange, asking if I wanted to receive warmer responses going forward. I was astonished.

This: “I can be whoever you want me to be” and “You need to be whoever I want you to be” dynamic sits at the core of every narcissistic relationship. ChatGPT was perpetuating it, leading me deeper into my own narcissism. Artificial therapy feeds narcissism, whereas real therapy — when it’s good — creates an environment in which a patient can recognize narcissism, understand where it comes from inside them, and then grow through it.

What I’ve learned as a patient in psychoanalysis, and working as a psychodynamic psychotherapist, is that the single most valuable thing that I can offer my patients is my own capacity to feel — and to recognize what I cannot bear to feel. Nothing is more crucial to the formation of a good therapist than the slow, painful process of our own personal therapy, and growing the ability to recognize and tolerate all the feelings you would rather run away from. This is how we can help our patients turn towards the emotions they cannot bear, and help them understand their roots and put them into words.

Perhaps I sound like some sort of caricature of a Gen Z snowflake, banging on about feelings. Actually I’m a middle-aged Millennial. I grew up with one foot in analog childhood, the other in digital late adolescence, and the more patients I see, the more I recognize just how extremely confused about feelings our society has become. Feelings are important — but not in the way most people these days seem to think.

The “stiff upper lip” culture of the boomer generation and the silent generation before it caused terrible harm. Brushing off feelings as if they are irrelevant can leave you weighed down by depression. And now we see how today’s Gen Z culture, with its safe spaces and trigger warnings and language police — not to mention AI therapy — has swung so far the other way that they’ve landed at the other end of the horseshoe. Both generations are so frightened of emotions that they crave protection from them at all costs.

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Both cultures result are caused by an inability to tolerate unwanted feelings of any kind. Both cause the same despair, isolation and brittle sense of self. I see it in my consultation room in patients of every age, whatever their background. The facility to tolerate, feel and understand our own unwanted emotions lies at the foundation of good mental health. It defines what it means to be psychologically resilient, to make good decisions and lasting relationships, a fulfilling career and a happy home that can also survive unhappiness.

When you can’t bear your emotions, you get into all sorts of trouble. You might unconsciously try to starve or fight or drink or gamble them into numbness, or spend your days and nights trying to scroll or screw them away. You might break up your relationships because you simply cannot tolerate the feelings that come with accepting that others aren’t available to you all the time. You might start a war because you cannot bear your own internal torment and emotional chaos, and you need to get rid of it by pushing it into faraway victims. You might lose yourself in online misogyny because you cannot bear your own unconscious, your desperate desire for the maternal capacities for love, care and attention. We all just want to feel better — but what we really need is to get better at feeling.

This is why I don’t think AI could do my job. No matter how many iterations it goes through, it will never be able to feel human emotion. But this is also why I think AI therapy is so dangerous; it offers a masquerade of care — something that looks like it cares, but really doesn’t care at all. That’s why it’s called artificial. This dynamic is what sits at the root of the most dangerous relationships. And if it’s all you know, you may well end up repeating it, unconsciously, for the rest of your life.

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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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.