Book Review: Therapy Nation
Jonathan Alpert, Therapy Nation: How America Got Hooked on Therapy and Why It’s Left Us More Anxious and Divided. New York: Hanover Square Press, 2026. 320 pp.
When I was in graduate school training to be a therapist, we held review sessions with our professors. During a meeting with the department chairman, I pulled out my VHS tape of a counseling session and pressed play. Thirty seconds in, he stopped the tape, looked at me, and asked, “What are the goals for therapy?” “To help them get better,” I said. “That is incorrect.” Therapy without measurable, realistic goals, he explained, is not really therapy.
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I have never forgotten the lesson.
Jonathan Alpert has written a whole book about it. In Therapy Nation, he argues that therapy without direction, goals, and accountability for results has become far too common—and that a culture soaked in therapeutic language has grown more anxious, not less.
The Mental Health Crisis Paradox
Alpert opens with a paradox. More Americans are in therapy than at any point in our history, and our collective mental health keeps deteriorating. His conclusion is blunt: the more therapy people receive, and the more people consume therapeutic ideas, concepts, and language, the more fragile and anxious they seem to become. He presents statistics to support his hypothesis. Gallup data showing that Americans’ assessment of their own mental health has eroded, with the decline sharpest since the pandemic and steepest among the young. 30% of Americans between eighteen and twenty-nine, and 24% of those between thirty and thirty-nine, are affected by anxiety or depression.
Alpert suspects the two facts are related, and that the trouble lies not in access but in overexposure. But a discerning reader might also ask whether Alpert has connected facts that merely coincide. Correlation is not always causation. The correlation is intriguing, but it leaves unanswered whether therapy produces greater distress or simply responds to a culture already growing more distressed.
Therapy-Speak Goes Mainstream
Alpert’s illustrations seem cultural rather than clinical. Thanks to the internet, therapeutic vocabulary has escaped the consulting room and become a way of seeing the world. Words like trauma, boundaries, toxic, and self-care now turn up in boardrooms, classrooms, and political campaigns, where they carry clinical authority without clinical discipline. And alongside every other influencer subgenre, mental health influencers now dispense advice with no training behind it and no accountability for what it costs.
The book surveys all these cultural trends (victimhood, excessive validation, self-diagnosis, politicization, and the medicalization of ordinary distress) and indicts therapists who reinforce them. Not every difficulty needs to be pathologized.
Against Therapeutic Culture, Not Psychotherapy
But a question presses on every page. Does Alpert identify cultural trends that appear in some therapy practices, or has psychotherapy as a whole lost its way? Despite its title, Therapy Nation works better as a critique of therapeutic culture than of psychotherapy itself. What Alpert is attacking is not therapy itself, but rather society’s addiction to its norms.
Anecdotes and Generalizations
Alpert’s chapters follow a consistent pattern. He opens with a provocative example, usually drawn from the news. Then, he connects it to a clinical story, often from his own practice. Finally, he draws a cultural observation, then closes with a broad generalization about therapy. His examples are not false, and many of them genuinely trouble the reader, but they remain anecdotal. Anecdotes can illustrate a phenomenon, but they cannot establish how common it is. That distinction becomes increasingly important as the book unfolds. He rightly points out some of the risks that the rapid expansion of telehealth created during the pandemic. Increased demand and easier access opened the door to questionable practices and poor-quality care. He is right that the therapy room is a place where values get discussed, and that some therapists impose their own politics on clients who came in for help with something else.
Self-Diagnosis and Therapy-Speak
In my view, he really hits his stride in chapter seven, “Munchausen’s by Google.” The internet increasingly feeds us what we already believe, and confirmation bias does the rest. Self-diagnosis follows, and with it the overuse of terms like narcissism, borderline, and bipolar. In my own practice, I call these the flavor of the month, and Alpert argues that therapists should do more to challenge Google’s “diagnosis,” rather than ratify it. He is equally sharp on therapy-speak. When toxic, trauma, and trigger get applied to every discomfort, the words lose their power to name real suffering. Alpert discusses in many places the need for therapists to challenge clients’ thinking, but he never shows how widespread this behavior is across mental health in America. Healthy therapy carefully mixes affirmation and challenge. That distinction becomes the book’s central weakness.
Salience Is Not Prevalence
But here is my central concern. Vivid examples do not establish prevalence. A handful of therapists promoting questionable practices on social media tells us very little about how representative those practices are among the hundreds of thousands of licensed clinicians working in the United States. Alpert consistently points to the dysfunctions of expanded access while giving little attention to its benefits: interstate licensing compacts, rural coverage, and far greater availability of specialized clinicians.
Evidence and Professional Context
In his final chapters, Alpert helps readers distinguish harmful practices from evidence-based ones. He grounds his criticisms of psychoanalysis and humanistic therapy well, but he never establishes how prevalent those approaches actually are today, or how they shape clinicians who would never claim those labels.
He recommends Cognitive Behavioral Therapy, Dialectical Behavior Therapy, and Eye Movement Desensitization and Reprocessing, yet offers little outcome research to explain why a reader should prefer them or how effectiveness varies across disorders and populations. Readers get almost no sense of the breadth of evidence-supported psychotherapy: Acceptance and Commitment Therapy, family and couples therapies, and specialized approaches for children. Anyone seriously evaluating the profession must engage treatment outcomes, therapist effects, and the therapeutic alliance.
The book also passes over the practical questions a church member actually needs answered. What is the difference between a psychiatrist, a psychologist, a licensed counselor, a clinical social worker, and a marriage and family therapist? What do licensing boards and regulatory agencies actually do? How do graduate programs form competent clinicians? Without that, the claim that America is “hooked on therapy” lacks the specificity to be actionable.
Anglicans on the Couch
Therapy Nation belongs on a clergy or vestry shelf, but not in the hands of a parishioner who is presently struggling and looking for a reason not to make the appointment. Rectors, pastoral care teams, and lay leaders will find it a useful provocation. It will sharpen the questions you ask when you make a referral and help you recognize the cultural distortions that Alpert rightly names. Read it in dialogue with a Christian mental health provider in your parish or deanery, someone who can help you sort the real concerns from the sweeping ones. “In an abundance of counselors there is safety” (Prov. 11:14) cuts both ways here.
I have long believed that collaboration between the church and mental health professionals is essential to a healthy parish. The challenge for Anglican leaders is neither to embrace therapy uncritically nor to reject it reflexively, but to “test everything” and “hold fast what is good” (1 Thess. 5:21).
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