Where Did Psychotherapy Go Wrong? | Ian Cox
3 September 2026
With Ian Cox
Ireland
Ian Cox, Irish psychologist and lecturer, joins Stella O'Malley to examine how postmodernist and activist-led ideology has displaced evidence-based thinking inside psychology and counselling training. The conversation traces how this shift affects what students learn, what clinicians feel permitted to say, and what clients ultimately receive — particularly those presenting with gender distress. At stake is whether the therapeutic professions can sustain the scientific foundations that distinguish them from advocacy, and what professional accountability looks like when dissent triggers complaints and doxxing.
Ian Cox is an Irish psychologist and lecturer whose professional life has placed him at the intersection of academic psychology and what he describes as a growing ideological incursion into the field. In this conversation with Stella O'Malley, Cox argues that postmodernist frameworks and activist priorities have progressively undermined the scientific and empirical foundations that psychology and counselling have historically rested upon. His account is not abstract: it is grounded in his direct experience inside lecture halls, clinical training programmes and professional networks. The episode opens with what Cox terms an assault on science within the helping professions. He describes a curriculum environment in which knowledge claims that were once subject to empirical scrutiny are increasingly settled by appeals to identity and lived experience. For practitioners trained in traditions that prize falsifiability, replication and peer review, this represents a fundamental change in how the professions define what counts as valid evidence. The concern is not merely academic: when the evidentiary bar is lowered or displaced by ideological consensus, the clients who rely on clinical judgement are the ones who bear the consequences. Cox describes in detail what happened when he questioned these developments inside his own institution. Student pushback, a public social-media pile-on, formal complaints and doxxing followed. The episode situates these experiences within a broader pattern that has become familiar across European and Anglophone academic contexts: practitioners and academics who raise evidential or methodological concerns about current directions in psychology — particularly around gender identity — encounter coordinated professional and social pressure intended to silence them. Cox also discusses a case in which a student appears to have faced serious consequences for a comparable act of dissent. A substantial part of the conversation concerns what Cox describes as clinics moving to fully affirmative models. From an evidence standpoint, this development is significant. The approach in question involves accepting and affirming a patient's stated gender identity without the kind of exploratory, psychotherapeutically rigorous assessment that clinical guidelines in Sweden, Finland, England and Denmark have recently moved to require. The Cass Review, published in 2024, found the evidence base for affirmative-only practice with under-18s to be of poor quality, and several European health authorities have revised their national protocols accordingly. The tension Cox identifies between advocacy-led clinical culture and the emerging European evidence consensus is live and, as yet, unresolved. The episode's closing section returns to first principles. Psychotherapy rests on professional and ethical commitments — exploratory neutrality, the client's autonomous development, the use of best available evidence — that distinguish it from pastoral support or ideological advocacy. When those commitments are treated as obstacles rather than foundations, the character of the profession changes. Cox's account raises the question of whether regulatory bodies and training institutions are currently equipped, or willing, to defend those foundations when the pressure to conform originates not from outside the profession but from within it.
