* Therapists may rely excessively on distracting the client from issues that trouble him; e.g., relaxation training, meditation, or therapeutic exercise can help clients break out of a cycle of self-preoccupation. Self-absorption {275} perpetuates emotional suffering; distractions can therefore be invaluable. But if a client's underlying self-defeating attitudes are not confronted, distraction alone will not be enough to bring about lasting change. * Therapists may rely too heavily on getting clients to "think positively." Positive thinking can undermine a client's already shaky confidence if he fails to achieve the goals that positive thinking led him to expect. These are undeniable shortcomings of therapy. They can reduce the effectiveness of therapy, or negate its constructive effects, or even cause clients to accept the therapist's belief that their condition is worse than they thought and so persuade them to feel, and to be, even more troubled. It is important to be aware of these signs of what Ellis rightly calls incompetence in therapists. It is also important to realize that psychotherapy is not unique in having to deal with professional incompetence. Physicians can and do fall victim to many of the same excesses: needlessly alarming patients, misdiagnosing their conditions, and sometimes treating them in ways that lead to a general worsening of their health. Iatrogenesis exists in medicine as well as in psychotherapy. Until the day when the world is a perfect place, we simply have to take _caveat emptor_ to heart--let the buyer beware. A Ph.D. in clinical psychology, certification in marriage and family counseling, or an M.D. with specialization in psychiatry unfortunately does not guarantee against human fallibility and lack of wisdom. WHEN PSYCHOTHERAPY IS SUCCESSFUL It might be argued, then, that the worth of psychotherapy to the consumer (the client) does not depend on its being superior to a placebo. Whether it is or is not superior is a theoretical question of interest to theoreticians; in judging the practical worth of psychotherapy, what matters is consumer satisfaction. Judged by the latter criterion, psychotherapy is indeed worthwhile.[15] [15] Edward Erwin, "Is Psychotherapy More Effective Than a Placebo?," in J. Hariman, ed., _Does Psychotherapy Really Help People?_, p. 48. {276} There is a world of difference between popularity and effectiveness. Is psychotherapy only popular and simply ineffective? All approaches to therapy have a built-in expectation that positive change will result. This belief implicitly is communicated to clients, and it can provide them with a sense of hope that replaces the helpless and demoralized state that has motivated them to seek therapy.