Therapy and Incentives

Say that you see somebody throwing away a crumpled piece of paper and you offer them five dollars for it. What do you expect to happen? I would expect them to sell you the piece of paper.  I’d also expect that if they see you the next day and they have a piece of paper available, they’ll crumple it up and (pretend to) throw it away—because they have a chance of getting another five dollars.  If you give them five dollars again, they’re likely to repeat the behavior as often as they can when you are around and perhaps tell other people who will also repeat it.

If people know that someone is willing to pay for something that’s not particularly valuable otherwise, they will make that thing available.

The above is a response to Peter Singer’s child drowning in a pond example used to argue for humanitarian foreign aid.  We likely all agree that we should save the child drowning in a pond, but if we also give the child something that’s a benefit to either them or their parents, we incentivize them to repeat the action (or pretend to).  In some places, it’s been reported, children are crippled to make tourists more sympathetic, thus making it likely they will give them more alms.  That’s the same dynamic: incentivize something and you get more of it; unfortunately, what is incentivized is crippling a child.

If you reward people for (pretending to) throw away crumpled pieces of paper, they’ll do so.  If you reward people for (seeming to) have a child drowning, you should expect more kids to appear to be drowning.  If you reward people for making kids worse off, they’ll do so.

Something similar may be going on now with therapy.  When we encourage people to go to therapy and treat them kindly for it, they feel rewarded. The result?  We incentivize more therapy.  In part, this may be a good thing.  More people may need therapy then currently get therapy and some that do likely could use more.

The worry is that we may be overdoing the incentives.

Many of us now use and reward therapy speak at home, in the workplace, and in schools.  It’s at least plausible that we’re overdoing it and people are incentivized to engage in therapy rather than the performing other tasks, some of which may be important and/or healthier than therapy.  This seems to be the basic (and plausible) idea in Bad Therapy: Why the Kids Aren’t Growing Up, by Abigail Shrier (for the excerpt I read, see this; find the book here).

I suspect Shrier is right.  To be clear, I think therapy is useful for many and can be useful to more people; its overuse by others may nonetheless be a problem.  There are at least two worries.  First, as some overuse therapy, others can’t get any (there is a limited supply of therapy time; too few therapists for everyone to make use of them).  Second, some may replace more productive and helpful activities with therapy or use therapy (or what they learn in therapy) to their detriment, including preventing themselves from working hard in school, in their careers, or on their relationships.  Such people may come to think of themselves as having more problems than they would otherwise.

I have no solution to offer here, but I do think it is a problem.  We need to find a better balance where people that genuinely benefit from therapy are able to get it without stigma but where those that can do better without it, don’t.