The Parts of Mental Health We Don’t Say Out Loud

As clinicians, we’re trained to speak with confidence.  We learn models, interventions, and language that signal clarity—certainty, even.  And to be fair, confidence matters. It helps clients feel anchored. It helps us take action.  But underneath that confidence, the data is often more modest than our language suggests.  The field of mental health operates on a mix of evidence, approximation, and narrative.

And I wonder what happens when we’re more honest about that—not in a way that destabilizes our work, but in a way that grounds it.

Psychiatric medications help many people.

And the numbers matter here:

• Roughly 50–60% of people respond to medication
• Around 30–40% respond to placebo
• Leaving a 10–20% net effect

That’s not nothing. It can be life-changing for some.  But it’s also not the kind of sweeping, predictable transformation our language can sometimes imply.  For many clients, medication is one piece of a larger, more complex process—not the whole solution.

We teach models as if they are stable, settled, and fully agreed upon.  As Donald Meichenbaum once provocatively put it, “all psychotherapy is bullshit”—not because it doesn’t work, but because no single model accounts for what actually creates change. The frameworks we use are: Clinically useful; Conceptually compelling; And, scientifically debated. Take Polyvagal Theory as one example.  It has deeply shaped how many clinicians understand the nervous system. It offers language that resonates with clients and supports meaningful shifts in therapy.  And—it is also actively debated in scientific circles.

Both can be true at the same time.  The risk is not in using models.  The risk is in presenting them as unquestioned truth.

The word “placebo” has often been used to imply something inert, secondary, or even dismissible.  But the research tells a more interesting story.  Open-label placebos (where people know they are taking a placebo) can still produce real effects.  The meaning response—what someone believes, expects, and experiences—plays a measurable role in outcomes. The brain is not just reacting to interventions.  It is participating in them.  Which means what we offer is never just the technique—it’s also the meaning surrounding it.

If we take all of this seriously, it shifts the frame.  Our job may be less about delivering the right model or the correct explanation…

…and more about offering frameworks that create movement.  Frameworks that help a person:  experience themselves differently; relate differently; and respond differently

Not because the model is perfect—but because it is useful.

Maybe the question isn’t:

“What’s the right model?”

Maybe the question is:

“What helps this person move, function, and relate differently?”

And maybe part of our work—especially as clinicians—is learning to hold both:  Integrity with the data.  Humility about what we don’t know.  Without losing our ability to help.