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Advice columnists frequently urge their troubled letter writers to get professional help: “Seek counseling” or “Ask your mate to find a therapist.”

Many Americans share this confidence in psychotherapy’s effectiveness. Before 1950, psychiatrists were the primary providers of mental health care. Today’s providers include clinical and counseling psychologists, clinical social workers, clergy, marital and school counselors, and psychiatric nurses. With such an enormous outlay of time as well as money, effort, and hope, it is important to ask: Are the millions of people worldwide justified in placing their hopes in psychotherapy?