In little over a hundred years, psychotherapy has expanded from a tiny, marginal, quasi-medical profession to a multi-billion-dollar healthcare industry. As we said before, in the nineteenth century, the forerunners of modern-day psychiatrists limited themselves to managing “mad” people confined in lunatic asylums (as mental hospitals were then called). There were no clinical psychologists, counselors, family therapists, psychiatric social workers, or life coaches in those days. It was only in the latter half of the twentieth century that the reach of the mental health professions began to expand into everyday life as professionals shifted their sights toward making the general population more satisfied, better adjusted, and more productive (Horwitz, 2002). This expansion began in North America, where it has been especially pronounced, but similar patterns of growth have occurred in several other western, high-income countries.

People in many western, high-income countries today turn to therapeutic experts for authoritative advice about who they are, who they could be, and who they should be. Consultations with psychotherapists are no longer restricted to mental hospitals or even to therapy offices. Instead, therapeutic experts dispense advice via TV talk shows, the internet, self-help books, radio call-in programs, and self-improvement videotapes and seminars. Therapeutic experts render judgments and advice in courtrooms, in educational settings, in general medical practices, in election campaigns, and in government departments of defense, security, and intelligence. And therapeutic experts rush to give assistance at sites of manmade and natural disasters, as well as criminal investigations. Therapeutic practitioners are called on to offer expert evaluation, advice, relief, and reassurance for nearly every aspect of people's lives from infancy to death.