Adam Blatner

First of all, “good candidates” for psychotherapy are willing to locate the source of trouble in the self rather than others. Many people are not good candidates because they blame others, including the current President of the United States (POTUS). Many people agree with Trump in believing that were it not for the dummies, the losers, the (some minority or perhaps several), we wouldn’t be in so much trouble. They feel their own wishing that things would go well and that their own consciously benign attitude generalizes, so that it becoming impossible for them to consider that their own behavior may be misguided and making things worse. To take an “Maybe I’m not okay” role is unthinkable, because it is magically excluded by the thought that “I mean well.”

Another source of disturbance is that many people cannot envision greater good than their own prosperity. Prosperity for others is due (in their minds) to their lack of ambition. That they themselves have benefitted from other’s success—via inheritance or other lucky circumstances— is not considered.

Another type of person not only can tolerate some feelings of personal inadequacy, but seeks to change these by changing themselves. These might do well with psychotherapy, and other personal growth programs.

Still, it’s good to recognize that many other people are unconsciously defending their self-esteem through denial, thinking “There’s nothing wrong with me, it’s the others who are if not against me, then either not doing their part or unfairly working against me.” The election of Trump shows that this is not an insignificant number of people!

Many people—perhaps a majority—in spite of blaming others, fall victim to life not working for them, and thus they develop symptoms. They may exhibit certain types of psychopathology, enough to be given a diagnosis, but will not be good candidates for psychotherapy! These are not psychologically-minded, which is to say, they take an “I’m Okay, You’re Not Okay” stance. Their motivation to change is shaky: Others should change, not themselves. Perhaps they will be offered some, and some will accept it grudgingly, and their improvement may be minimal, but detectable.

On the other hand, psychologically minded people (perhaps less than the majority of people!) might benefit from many types of therapy out there, but the simplest and non-troubling, cheapest, and most available will get more customers, because many people believe that consciousness-change is a commodity that can be bought and sold.

Thus, mind-enlargement through casting off of neuroses happens much much easier  for those with mild disturbances and no coexisting conditions. It gets much harder if there is any co-morbidity—doubly difficult if there are two co-morbidities, as each additional condition reinforces the others.

For these and other reasons the expressive therapies might consider recognizing their connection with mind-expansion. This accounts for only a distinct minority of the population. All this bodes ill for all forms of psychotherapy, and those that cannot demonstrate “effectiveness” for all kinds of psychopathology and all kinds of patients tend to be marginalized by the bean-counters.

Responding to these conditions, one tactic is a joining of our two fields,drama therapy and psychodrama, as the differences between them—obvious to those in those fields—are not so apparent to those outside the fields.

Another tactic is to critique the place of therapy in the culture, as I have in the earlier paragraphs. The majority is not ready for introspection. I’m not sure what specific changes I would suggest in the conventional training in the mental health professions.