Therapy doesn't always work. Sometimes, it makes things worse. And a study indicates that the only person guaranteed to feel better about life after someone sits down on a psychologist's couch is the psychologist.
In a special report being published next month to coincide with the 10th anniversary of 9/11, the journal American Psychologist has suggested that in their eagerness to help survivors to cope with the terrorist attacks, some mental health professionals may have exacerbated the trauma.
Experts greatly over-estimated the number of survivors who might want treatment, and used discredited methods to help those who came to see them.
Mental health professionals flooded into New York after 9/11, according to the report, which describes their response as "trauma tourism". Freudian analysts set up shop at fire stations, while major employers, who had never had to cope with a comparable disaster, asked professionals to install therapy centres in their offices.
There was but one problem: for many New Yorkers, reliving the events by talking about them simply exacerbated the trauma. And while no one will deny that some of the survivors who received treatment ultimately benefited, opinion is divided as to whether it represented a net benefit for the overall majority of patients.
"We did a case study in New York and couldn't really tell if people had been helped by the providers – but the providers felt great about it," Patricia Watson, a co-author of one of the articles who works at the National Centre for Child Traumatic Stress told The New York Times. "It makes sense; we know that altruism makes people feel better."
Standard operating procedure for therapists working at the time was to ask distressed clients to talk through their experience. But researchers now believe that process can sometimes plunge people deeper into depression or anxiety.
Richard McNally, a psychologist at Harvard, told the newspaper that 9/11 "brought attention to the limitations of this debriefing," which can rake over painful emotions that are sometimes best left undisturbed. It also led to a debate about the causes and potential effects of so-called post-traumatic stress disorder.
In the immediate aftermath of the attacks, many therapists believed that simply watching news footage of the events could prompt a similar reaction to having been there. But the extent of that kind of trauma was vastly overestimated. "The notion that TV caused PTSD seems absurd," Dr McNally added .
Studies in the journal also show that Americans who were personally affected by the attacks are more fearful of terrorism but less supportive of overseas intervention by the US than average citizens.
In defence of the US therapy industry, Roxane Cohen Silver, a psychologist at the University of California, who oversaw the special issue of American Psychologist, said the unprecedented scale of the 9/11 attacks meant they were in operating largely in unchartered territory. "Before 9/11 we didn't have any good way to estimate the response to something like this other than – well, estimates," she said.