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Is "Bad Therapy" Harming Children?


Last month, Elon Musk endorsed “Bad Therapy,” a new book written by a reporter that places blame on mental health therapists and trauma-informed care as the cause of the children’s mental health crisis.

The book proposes that children’s mental health professionals are taking advantage of their clients by intentionally keeping them in a therapy loop to make money. The author also posits that the trauma-informed movement is the catalyst of the children’s mental health crisis and is intentionally harming our kids.

I do not deny that we have “bad therapy” taking place in the U.S. I’ve heard my fair share of stories to know it’s real. In particular, modalities like Applied Behavior Analysis have received backlash from the autism community over their abusive and traumatizing practices. I also had trouble finding a good therapist for myself in the past, and one instance where a therapist triggered me. Maybe I’ll share that story one day!

But, I find it wildly irresponsible and potentially harmful to paint every therapist with the same brush and reduce a complex issue, like children’s mental health, to one group of people.

Even more concerning is the book’s denouncement of trauma-informed care, SMH.

So what’s causing the children’s mental health crisis, in my opinion?

I think we have an over-taxed, bare-bones mental health system that has been underfunded and deprioritized for decades until the mental health epidemic reached a tipping point during the pandemic, becoming too big to handle.

To support my opinion, let’s take a look at some recent research concerning the state of children’s mental health care in 2024:

According to research by the National Institute of Mental Health, 70-80% of American children do not have access to mental health treatment. These numbers make it difficult for “bad therapy” to be the sole cause of the children’s mental health crisis, as a lack of access to care spans every community, race, and socioeconomic status. However, as usual, it impacts BIPOC at disproportionate rates.

In 2022, only two states—Washington, DC, and Idaho — met or exceeded the current recommendation of one psychologist for every 500 students in public schools. THIS IS UNACCEPTABLE.

Almost 60% of youth who reported at least one major depressive episode a year did not receive any treatment. That number in some states like Kentucky, Hawaii, and South Carolina skyrockets to 75% and 80%.

Access to care for those with mental health concerns has been shown to help IMPROVE their quality of life and mitigate symptoms.

Of those who sought mental health care in 2021, 67% said they received effective treatment.

I could go on, but you get the idea.

How can “bad therapy” be the cause of the children’s mental health crisis when the research shows so many children are falling through the cracks and that most of the children who do receive care find it to improve their lives?

For a full discussion on this topic, listen to my podcast interview with Ingrid Cockhren, CEO of PACEsConnection.

To round out this conversation, we have to talk about which children are receiving mental health therapy in America.

According to the results of the National Health Interview Survey in 2021 (latest results):

  • White children continue to receive the most mental health treatment in the US.
  • Asian non-Hispanic children receive the least amount of mental health treatment
  • Boys receive more medication as treatment, while girls receive more psychotherapy

It’s important to note that as urbanization declines, so does the number of children with access to therapy

This begs the question, are the children who can access trauma-informed therapy privileged?  

As a trauma therapist in the US, below are my additional observations on which children have access to trauma-informed therapy:

  • Children who have parents with robust healthcare insurance that covers dependents
  • Children with parents who can afford to pay out of pocket for seasoned therapists
  • Children with parents who have time and transportation to take their children to therapy between the hours of 9 am -7 pm
  • Children who live in urban or suburban areas of the country where they have access to trauma-informed mental health clinicians
  • Children in school systems that can afford mental health professionals in their budget

Online therapy for children removes some of these barriers, but not all. You still need access to technology, the resources to pay for treatment, and private space to attend online sessions. Many homes do not have quiet space for homework, let alone therapy.

This obvious lack of access to care is only the tip of the iceberg when it comes to children’s mental health crises.

Other Factors Contributing to the State of Children’s Mental Health in 2024:

  • Racism, violence, and discrimination against any group of people is a pervasive trauma. Full stop. BIPOC and the LGBTQI+ community have to navigate their day-to-day lives fighting an uphill battle against prejudice and discrimination. Over time, this leads to “weathering,” a term coined by Arline Gernonimus, a professor at the University of Michigan. Weathering describes the negative impact of oppression over time on individuals who are non-white and non-heterosexual.
  • The opioid epidemic is destroying our communities. Substance misuse is predominantly a coping mechanism for trauma. We’ve lost a generation of parents to substance use, which only perpetuates the cycle of trauma for the next generation. We have approximately three million grandparents raising grandchildren in the U.S. due to neglect/abuse by their biological parents, mostly caused by their unaddressed trauma that led to substance misuse.
  • Pandemic isolation, fear, and death of family members pushed children, who were already struggling, over the threshold of what they could cope with, leading to childhood despair.
  • The use of screens and social media has soared since 2020, making children more vulnerable to online bullying, abuse, and predators.
  • Transgenerational traumas, like slavery and the holocaust, are passed down to offspring through learned behavior and epigenetics, which results in exponential mental health problems in children and youth as time goes on.
  • Caregivers are overwhelmed by their unprocessed traumas, the state of our world, and work-life stressors. This makes them feel irritable and emotionally dysregulated when they have time to spend with their children, which is also known as parental burnout.
  • Our schools keep children inside most of the day when we know what’s best for their mental health is time spent outdoors, in nature (if possible).
  • We cut funding to art, music, and health programs when we know these programs help children regulate their emotions and improve mental health.
  • We force academic learning at ages 2, 3, and 4 instead of allowing children to explore, play, and socialize.
  • At six weeks old, we separate babies from their primary caregivers to go to work when we know they need secure attachment and consistently attuned primary caregivers early in life for healthy brain development.
  • According to the National Institutes of Health, up to 45% of new mothers experience birth trauma—and the effects can continue long after the birth itself.
  • Fathers and babies also experience birth trauma at alarming rates, setting off a cascade of problems, including a parent’s ability to work and function with postpartum depression and anxiety.
  • Systemic problems like substance use, poverty, racism and other “isms”, climate crisis, war, harmful school practices, fearmongering news, and mass shootings cause terror and despair in children.
  • We overdiagnose children with “disorders” and medicate them instead of supporting them through their natural responses to trauma and loss.
  • Our family court systems traumatize and retraumatize children in the name of parental rights.
  • It’s STILL socially unacceptable for boys and men to express feelings of sadness or anxiety, which means they often express it in anger, which can be projected on their family members.

Sadly, this is not a complete list.

You might say, “Most of the items on your list are not new problems; these issues have always resulted in mental health problems,” and you would be right.

However, I would say the psychological impact of these problems compounds from generation to generation, resulting in the mental health crisis we are coping with today.

I want to be clear that I’m not saying “bad therapy” and poorly executed trauma-informed care aren’t a problem.

Psychotherapy is an art form, and not everyone can guide people through mental health problems. Some will even be harmed by the bad advice they receive in therapy. I’m not disputing these points.

We must be vigilant about high standards for professionals and those who work with children to be trauma-responsive and healing-centered.

However, if we want to place blame on something for the mental health crisis, it shouldn’t be at the individual level but at the broader systemic level.

I do not believe that “bad therapists” are the largest contributor to the children’s mental health crisis, and we do society a disservice when we distract people from the real issues by pointing fingers at those who are trying to help.

Lastly, what can we do to heal the children’s mental health crisis?

  • Focus heavily on infant/caregiver attachment. This means we allow parents to spend as much time as possible with their infants from 0-3 months of age, at a bare minimum
  • One caring adult. Research from the Center for the Developing Child at Harvard University shows that children thrive with only one fully committed and compassionate adult. This means we must put more value into adult/child relationships and create a society that fosters these connections instead of breaking them down
  • Social support and consistent child care for working parents and other primary caregivers
  • Protect children from online abuse and the overuse of social media/screens
  • Commit to psychological safety at home, in school, and out in the community
  • Provide access to financial support instead of child removal due to poverty (aka neglect)

This only scrapes the surface of what we can do to increase attachment and heal the children’s mental health crisis.

I hope my observations and overview of the research shed light on the children’s mental health crisis in 2024 so we can develop policies and practices that heal and prevent trauma for our nation’s most valuable people – our children.

Please share your thoughts on this topic in the comments. If your opinions differ, that’s ok with me, but I ask that you please be respectful.

To learn skills to help children heal from childhood trauma, please visit BethTyson dot com and subscribe to my weekly newsletter.

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Comments (2)

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I appreciate this thoughtful post very much. I'll add the climate crisis to the endless list of stressors on youth.

I agree with the point of having at least one caring adult, but we desperately need to raise the bar much higher. Besides seeing the world through a PACEs lens, I also see it through the recognition of what helped human beings, for over 150,000 years, become the dominant species on earth (not suggesting us becoming dominant has been a good thing). We flourished in part because the traditional way of living was as relatively small tribes with all adults and older kids involved with tending to the younger kids, so each child had many people nurturing them. Increasingly in my lifetime, families are isolated, and kids often have just one parent/caregiver. Then at school there are 30 kids to 1 teacher. Furthermore, what little socialization kids have is too often only with kids about their same age, meaning they're missing out on more life-learning experiences from older people.

I'd say that even more important than focusing on improving access to counselors (though I'm all for counseling) is educating people on PACEs science, which would then hopefully motivate communities to organize frequent events and opportunities for kids and adults to gather, while also motivating adults to get involved with kids who aren't their own. We need to relieve the pressure on parents as being the ones to raise kids; as Beth pointed out, they're OUR children.

Beth -

Thank you for this thoughtful, researched, reasoned response to a “gotcha” book title and topic promulgated by people who simply what the headline and the book sales while casting blame and dodging responsibility.

Had Mr. Musk and his morbidly rich  cohort been taxed at an appropriate rate as proposed by Senator Elizabeth Warren, there would be more money available to prevent such massive gaps in our nation’s infrastructure and healthcare system. That’s just one part of this complex challenge. AND you have done a masterful job of taking this incredibly complex and multifaceted muliti-Damndemic, and putting cause and effect in a thorough yet concise article that needs to be submitted to The New York Times, WaPo, The Hill, and other for wide distribution.  
CNN and others need to be calling on you to speak to these challenges and solutions.

You have such a depth of understanding and are so articulate. This community is blessed by your contributions.

Thank you, my friend!

Carey Sipp

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