Bad Therapy

How can you help kids feel and function better without accidentally making them worse? In Bad Therapy: Why the Kids Aren’t Growing Up, Abigail Shrier argues that America’s therapeutic turn—across clinics, schools, homes, and apps—has unintentionally produced measurable harm, especially for children. Shrier’s core claim is stark: therapy is an intervention like any other; scale it indiscriminately, and you invite iatrogenesis—harm caused by the healer.

Shrier contends that the mental-health industry, persuasive school programs, and parenting trends have combined to medicalize ordinary childhood, reward suffering, and undermine agency. You see the human costs in dependency on sessions, overdiagnosis and pills, and a culture that treats kids as fragile rather than capable. To undo this, you must recover restraint: subtract what’s hurting (smartphones, surveillance, unnecessary therapy) and add what strengthens (independence, limits, real responsibilities).

The treatment-prevalence paradox

If treatments work at scale, prevalence drops. Yet as therapy and counseling have exploded, adolescent diagnoses and dysfunction have risen. Shrier cites national figures (e.g., 40%+ of youth having received treatment; 42% with a current diagnosis) alongside rising self-harm and suicide. She highlights research literally titled “More Treatment but No Less Depression: The Treatment‑Prevalence Paradox.” The lesson for you: more access isn’t more health if the interventions are misapplied or net-harmful when crop-dusted across basically healthy kids.

How harm spreads when therapy scales

The book catalogs iatrogenic pathways: psychological debriefings after disasters that worsen PTSD, group support that intensifies distress, routine grief counseling that delays recovery. Shrier adds common school practices that nudge kids to ruminate—daily “feelings check-ins,” trauma-sharing circles, and intrusive surveys about suicide or sex (often CDC-branded). These normalize pathology, teach over-attention to feelings (see Yulia Chentsova Dutton), and induce rumination (Leif Kennair)—two strong predictors of depression.

Institutions as therapeutic factories

Public schools now deploy SEL curricula (e.g., CASEL/Second Step), in-school therapy, and “restorative justice” procedures. Shrier describes classes melting into tears after circle time, and campuses where violent behavior increases as discipline is replaced by therapeutic rituals (see 75 Morton in NYC). Paraprofessionals shadowing students and multiplying accommodations (untimed tests, no-late penalties) often erode agency and teacher authority rather than build competence. Parents discover counselors met with their child without consent; the school’s “ally” posture can pit kids against families.

Trauma culture, empathy, and fairness

Trauma became a totalizing lens, popularized by Bessel van der Kolk and Gabor Maté. Shrier revisits the 1990s repressed-memory debacle (Elizabeth Loftus, Richard McNally) to warn that memory is suggestible; physiologic arousal doesn’t confirm truth. Resilience researchers (George Bonanno) show most people recover from severe adversity without chronic PTSD. Shrier also channels Paul Bloom’s critique: empathy’s spotlight narrows your focus to the tearful person in front of you, risking injustice to those absent. You see the costs in cases like Chloe at Spence School, where empathy-branded norms bred performative cruelty, peer policing, and public shaming.

Overdiagnosis, pills, and lost development

Labels can demoralize kids (“I am sick”) and set lifelong trajectories. Shrier profiles ADHD inflation (Yaakov Ophir’s critique of the “four Ds”), adolescent antidepressant use (Steven Hollon’s cautions), and polypharmacy risks. Meds can numb or blunt, often substituting for structure, limits, and exposure to tolerable challenges—the stuff that actually grows coping. The “pill reflex” often emerges where environmental subtractions (phones, chaotic routines) and authoritative parenting would do more good with less harm.

What to do instead

Shrier’s playbook is subtractive, principled, and practical. Remove the clear harms first (“remove the spoon,” i.e., restrict smartphones—especially in school). Replace therapy-by-default with parent-based interventions (Camilo Ortiz’s exposure approach), authoritative parenting (Diana Baumrind: warmth plus limits), and real independence: errands, chores, sleepaway camp, unsupervised play. Prefer fairness and procedure over empathy-driven punishment. Demand transparency and opt-in consent for school screening, and insist practitioners measure harms as well as benefits.

Bottom line

Treat therapy like surgery: sometimes lifesaving, often unnecessary, always consequential. Scale restraint, not rumination; independence, not surveillance; fairness, not performative empathy. That’s how you help kids grow up.

Shrier’s first move is definitional clarity: iatrogenesis means harm from the healer. In mental health, the harms are often invisible—no rashes or lab values to flag them—and the profession rarely tracks adverse outcomes. As a result, net-negative therapies can spread quietly, especially in school-age populations where suggestibility and peer contagion magnify effects.

Evidence of therapeutic backfire

You might assume counseling after a trauma helps. Yet studies show psychological debriefing can intensify PTSD symptoms; routine grief counseling can delay natural recovery; and group support can amplify distress by normalizing and rehearsing pain. Shrier invokes the D.A.R.E. program—therapeutic in tone, group-based in method—that inadvertently increased substance use among teens. The pattern: public, emotive rehearsal plus surveillance often drives rumination, social learning of symptoms, and identity formation around illness.

Ten common harm pathways for kids

Children are uniquely vulnerable to intervention effects. Shrier synthesizes clinicians’ warnings into a map of pitfalls:

• Over-attending to feelings (Yulia Chentsova Dutton): directing kids to monitor emotions trains state orientation and reactivity.
• Rumination (Leif Kennair): repeated recounting cements distress—the strongest predictor of depression.
• Making happiness the goal: chasing feelings backfires; schools sometimes reward visible suffering with status.
• Accommodating fears: removing stressors (untimed tests) robs kids of corrective exposure (Camilo Ortiz).
• Surveillance (Peter Gray): constant adult gaze kills private play—the lab for negotiation and resilience.
• Overdiagnosis: labels demoralize and self-fulfill (“I’m disordered”).
• Medication overuse (Steven Hollon): side effects, withdrawal, blunted affect, and missed developmental learning.
• Compelled trauma-talk: rehashing can embed pain (Richard Byng).
• Encouraged estrangement: therapy frames parents as root cause (Joshua Coleman).
• Treatment dependency: clients outsource agency to weekly sessions.

Structural blind spots in the profession

Therapists produce the very product whose harms would threaten their identity and livelihood. Unlike many medical subspecialties, mental health often lacks systematic harm-tracking. As Shrier notes, when your 12-year-old is pulled aside at urgent care to answer scripted suicide questions (NIMH form), a “low-threshold screen” can escalate into a label and a medical cascade—without parental context or consent. Absent adverse-event registries, these escalations rarely get counted as iatrogenic.

Safer defaults and better matches

You don’t fix iatrogenesis with despair; you fix it with fit. Shrier highlights parent-based interventions (Camilo Ortiz) that use graded exposures at home rather than weekly therapist sessions. Behavioral tools that emphasize action over introspection (Michael Linden’s “action orientation”) help kids practice doing instead of dwelling. When medication is warranted, clinicians should set clear goals, timelines, taper plans, and measure function—not just self-report mood—to ensure net benefit.

Key idea

Treat talk therapy, school counseling, and screening like any medical procedure: define indications, monitor outcomes, track harms, and stop what doesn’t help. The younger the child, the higher the bar for intervention.

Shrier’s paradox is intuitive once you hear it: if society delivers vastly more mental-health treatment, why aren’t we seeing less depression and anxiety? Instead, diagnoses and dysfunction rise. The book surveys decades of data, noting that even before smartphones, adolescent mental health trended downward. That complicates single-cause theories and shifts attention to how and where we’re intervening.

What the numbers show

By Shrier’s account, nearly 40% of the rising generation has received mental-health services (vs. ~26% of Gen X), and roughly 42% carry a current diagnosis. Teen suicide rose steeply in prior decades and again more recently; nonfatal self-harm climbed too. Meanwhile, therapists, counselors, and school-based programs proliferated. In medicine, effective treatments reduce prevalence (think antibiotics and infection). We saw the opposite here.

Partial explanations, incomplete cures

Overdiagnosis inflated by broadened categories (ARFID, wide autism spectrum labeling) surely adds to the numerator. Environmental stressors—smartphones, social media, COVID-19 lockdowns, climate anxiety—matter too. But Shrier stresses institutional responses: mental-health leaders largely failed to push for simple public-health steps, like phone-free school days or targeted age delays for first smartphones (compare anti-smoking advice before surgeries). During COVID closures, many mental-health bodies stayed quiet about the severe risks of long-term school shutdowns.

Technology’s therapy boom

Post-2020, venture-backed startups raced to scale “therapy for all”—from Talkspace’s therapy-by-text to pediatric-focused apps like Little Otter and intensive providers like Charlie Health. AI-enabled screenings and tele-therapies promised massive reach. Shrier’s concern isn’t innovation per se; it’s crop-dusting interventions without robust evidence or harm tracking. When the risk of iatrogenesis is real, scale multiplies harm as easily as it multiplies benefit.

Rebalancing the system

What would a paradox-aware policy look like to you? First, prevention through subtraction: collect phones at school, delay smartphone ownership, normalize off-screen social life. Second, narrow indications: reserve therapy and medication for clearly impairing conditions after environmental fixes and structured routines are tried. Third, accountability: demand outcome data that include adverse effects. Fourth, humility: acknowledge that interventions that feel compassionate (universal screenings; trauma-sharing circles) can worsen the very metrics they aim to improve.

Bottom line

The prevalence curve won’t bend by doing more of the same. It bends when you remove large, ambient harms (phones, isolation), reserve potent tools for those who need them, and measure both wins and wounds of the mental-health apparatus.

You send kids to school for academics; many now get a steady diet of therapy-lite. Shrier shows how SEL curricula, group disclosure rituals, intrusive surveys, and permissive discipline have turned schools into therapeutic factories—without the guardrails of clinical settings. The cost is lost instructional time, increased rumination, blurred boundaries, and in some districts, more violence with fewer consequences.

SEL and the emotions-first routine

Teachers are trained to open the day with feelings charts and “bones/no-bones” check-ins. Harmless? Shrier recounts Ms. Julie’s fifth-grade circle that dissolved into sobbing after kids shared family troubles; math evaporated. Repeated focus on unstable emotions trains state orientation (Chentsova Dutton) and primes peer contagion. Group therapy dynamics—especially among adolescents—can reward suffering displays and escalate distress.

Dual roles and ethical gray zones

School counselors and psychologists juggle roles as advocates, evaluators, and informants to administrators. That dual relationship would be unethical in therapy, yet it’s routine in schools. Parents discover their children received counseling—or even referrals—without consent. Confidentiality rules that sideline families create mistrust and position the school as moral arbiter over the home (see Second Step “I Spy” homework directing kids to observe family members).

Restorative justice and accommodations

After 2014 federal guidance, many districts embraced restorative circles over suspension. Shrier reports increased violent incidents at schools like 75 Morton, with victims pressured into public reconciliation with assailants. Meanwhile, paraprofessionals (shadows) and proliferating accommodations (untimed tests, late-work amnesties) can erode student agency and teacher authority. The intention—compassion—often yields dependency, inequity, and chaos for rule-followers.

Surveys, screening, and contagion

Districts deploy climate and risk surveys (including CDC Youth Risk Behavior items) that ask about suicide plans, sex at very young ages, and family conflict. Though PPRA restricts some topics, opt-out regimes and vague “voluntary” labels expose many kids to lurid prompts. Media science warns about suicide contagion when methods are highlighted; similarly, repeated questioning can normalize pathology. Some surveys even instruct upset students to seek a counselor—suggesting the tool may have just created distress.

Questions for your school

• Do daily lessons begin with feelings-sharing, and how often does it displace academics?
• Are trauma disclosures prompted in class activities or homework?
• What are suspension versus restorative outcomes, broken down by violence severity?
• Are surveys opt-in with clear parental consent, and can you see them in advance?
• What’s the school’s phone policy? (Removing phones is the cleanest, highest-yield step.)

Practical pivot

Refocus schools on academics and community norms: clear rules, fair discipline, privacy-respecting classrooms, and phone-free days. Treat clinical issues clinically—outside group lessons, with parental partnership, and with rigorous standards of evidence.

You’re told empathy is the cure, but Shrier shows how empathy—when used as the main decision tool—can produce injustice. Drawing on Paul Bloom, she argues empathy is a narrow spotlight that privileges the tears in front of you while ignoring the unseen stakeholders. The antidote is fairness: rights, rules, and procedures that apply consistently.

How empathy misleads

At work, leaders empathize with the struggling colleague and keep them in place—others suffer. In therapy, a counselor empathizes with the paying client and casts an absent spouse as villain, sometimes pushing divorce. In schools, the “first to cry foul” often wins before facts are gathered. During the 2020 social-media reckoning, students collected incriminating screenshots as “insurance,” then triggered empathy-driven administrative crackdowns; admissions offers were rescinded based on selectively surfaced digital artifacts (Ellen’s consulting example; New York Times reporting).

The Chloe case and peer policing

Chloe, a high-achieving Jewish teen at Spence, posted a private joke about bad costumes. Classmates escalated screenshots to administrators, who demanded racialized apologies despite the absence of clear harm. The school’s empathy-and-equity culture enabled punitive theatrics—students sought status by policing peers’ moral errors. SEL can invite performative moralism, where feeling deeply substitutes for judging fairly.

Gentle parenting’s parallel mistake

At home, “gentle” parenting turns empathy into method: validate everything, avoid consequences. Keith Gessen’s Raising Raffi chronicles a father overwhelmed by a violent toddler; sticker charts fail, one smack triggers spirals of guilt, and parental authority dissolves. Shrier returns to Diana Baumrind: authoritative parenting—warmth plus firm limits—most reliably produces independent, emotionally regulated kids. Many modern parents claim “authoritative” while practicing permissiveness or anxious micromanagement.

A fairness-first approach

You can treat people kindly while governing by rules. In disputes, ask: Who isn’t in the room? What evidence haven’t we heard? Build processes that gather countervailing testimony and weigh costs to absent parties (e.g., other students’ right to safety in discipline cases). In parenting, set clear boundaries, apply predictable consequences, and save emotional validation for moments it helps behavior—not as a universal prelude to compliance.

Key shift

Empathy belongs in relationships; fairness belongs in governance. Schools and families thrive when empathy informs—but does not overrule—rules and responsibilities.

When your child struggles—won’t sit still, panics at school, can’t sleep—you want relief. The fastest route today is often a label and a prescription. Shrier calls this the pill reflex and warns it steals the very experiences kids need to grow strong. Overdiagnosis converts mismatch into identity; pharmacology can blunt feelings that should be practiced, not avoided.

ADHD and the four Ds

Psychologist Yaakov Ophir describes being urged to medicate his four-year-old son Maayan with Ritalin. He resisted, immersed himself in the literature, and found ADHD often doesn’t clear the “four Ds” (deviance, distress, dysfunction, danger) robustly at young ages. He instead added structure, chores, and routines; Maayan thrived without meds. Ophir’s point: a diagnosis should reflect enduring impairment across contexts—not normal boyhood energy in an ill-suited environment.

Antidepressants and anxious teens

Shrier recounts Dylan, an 11-year-old with panic and stomach pain who ended up on Lexapro after a parade of medical visits. Steven Hollon and others caution that SSRIs and fast-acting anxiolytics carry substantial risks in adolescents: suicidality warnings, withdrawal, weight changes, sexual side effects, emotional blunting. Even when they palliate, they can interrupt adolescents’ learning to cope—robbing them of the mastery that reduces anxiety long-term.

Try subtraction before prescription

Before labeling a child disordered, subtract obvious stressors. Remove smartphones from school days; cut doomscrolling at night; add sleep, outdoor play, and chores; reintroduce graded exposure to feared situations. Many behaviors that look psychiatric are developmental or situational. Start with authoritative parenting: clear rules, warm support, calibrated independence (errands, bike rides, camp). Only after these environmental fixes—and robust evaluation—should you consider medication.

If you do medicate

• Seek a thorough, multi-informant assessment (parents, teachers, standardized tools).
• Set concrete functional targets (attendance, sleep, assignments) and track them.
• Plan for periodic taper attempts; beware polypharmacy creep.
• Pair meds, if used, with skill-building exposures—not avoidance.

Guiding principle

Labels should unlock specific, evidence-based help; they should never become a child’s identity. Prioritize growing capability over dampening discomfort.

Trauma language now saturates schools, therapy, and parenting. Shrier respects real trauma survivors but warns against universalizing trauma into a default explanation for ordinary struggle. The science of memory and resilience complicates popular narratives and points you toward a more sober, empowering path for kids.

Memory is reconstructive, not a tape recorder

Bessel van der Kolk’s The Body Keeps the Score and Gabor Maté’s work brought trauma into the mainstream, sometimes implying hidden wounds demand therapeutic excavation. Shrier revisits the repressed-memory era, when suggestive techniques produced false accusations; Elizabeth Loftus’s experiments show how easily vivid false memories can be implanted. Cathy Widom’s prospective studies—tracking children with documented abuse forward—found many expected long-term effects less robust than retrospective surveys suggest. Physiologic arousal during recall doesn’t prove historical accuracy.

Resilience is common

George Bonanno’s trajectory research and Martin Seligman’s work suggest most people recover from even severe adversity. Shrier shares family stories (e.g., her grandmother’s polio and poverty) to remind you that hardship doesn’t doom you to lifelong pathology. Overextending trauma frameworks risks teaching kids they are damaged by default, shrinking their expectations and effort.

From excavation to action

When schools prompt public trauma disclosure or therapists assume hidden abuse explains present problems, iatrogenesis looms. A better stance prioritizes present-moment functioning and skill acquisition: graded exposures, problem-solving, and real responsibilities. For many kids, the large lever is environmental subtraction—smartphones foremost. Shrier’s “remove the spoon” joke captures it: before pathologizing, remove the obvious irritant.

Build competence, not case files

• Give real jobs: send kids on errands with a list and cash; let urgency teach them.
• Encourage sleepaway camp, team roles, and chores (including the gross ones).
• Create phone-free zones and times—especially school hours.
• Protect private, unsupervised play; reduce adult surveillance.
• Tap extended family for stability and lore; grandparents matter.

Measured stance

Respect real trauma, verify claims with rigor, use targeted evidence-based care—and for the vast majority of kids, cultivate resilience by giving them room to do hard, real things.