Have we overestimated the effectiveness of psychotherapy?(digest.bps.org.uk)
digest.bps.org.uk
Have we overestimated the effectiveness of psychotherapy?
https://digest.bps.org.uk/2017/03/20/have-we-overestimated-the-effectiveness-of-psychotherapy/
147 comments
A) With regard to "no standards of treatment", that is not the case, at least in the US. Licensing and professional bodies for both Masters-level clinicians (LPCs, LMHCs, MFTs, MSWs and others) and Doctorates (PhDs, PsyDs) effectively mandate therapists rely on evidence based practices, and insurance companies are quick to push highly manualised behavioural therapies.
Private practice is one thing, but treatment outcomes are tracked in CMH settings as well as IP psychiatric settings.
B) Licensure is not all over the place. At a bare minimum, an independent clinician in the US will have several thousand hours of client contact (e.g. group facilitation), a thousand to fifteen hundred hours of 1:1 counselling with clients, a hundred hours of supervision, and have taken two years of graduate level coursework on psychology and psychotherapy, with the curriculum on its way to being standardised nationwide by CACREP.
Studies have demonstrated that treatment outcomes are not strongly correlated with clinicians' educational background, and that the perceived therapeutic alliance is the strongest predictor of success.
There are problems with psychotherapy research, but they're mostly those shared with the rest of the sciences.
Private practice is one thing, but treatment outcomes are tracked in CMH settings as well as IP psychiatric settings.
B) Licensure is not all over the place. At a bare minimum, an independent clinician in the US will have several thousand hours of client contact (e.g. group facilitation), a thousand to fifteen hundred hours of 1:1 counselling with clients, a hundred hours of supervision, and have taken two years of graduate level coursework on psychology and psychotherapy, with the curriculum on its way to being standardised nationwide by CACREP.
Studies have demonstrated that treatment outcomes are not strongly correlated with clinicians' educational background, and that the perceived therapeutic alliance is the strongest predictor of success.
There are problems with psychotherapy research, but they're mostly those shared with the rest of the sciences.
> A) With regard to "no standards of treatment", that is not the case, at least in the US. Licensing and professional bodies for both Masters-level clinicians (LPCs, LMHCs, MFTs, MSWs and others) and Doctorates (PhDs, PsyDs) effectively mandate therapists rely on evidence based practices, and insurance companies are quick to push highly manualised behavioural therapies.
A giant % of therapists around my area advertise that their treatment methodology is "eclectic".
Trying to find someone who follows even CBT is almost impossible.
I have seen at least a few people advertising themselves as following Freudian principles. So there is that.
> Licensure is not all over the place.
The quality of programs that provides those licenses are. And thousands of hours of training under someone who is not very good, does not lead to a good practitioner.
I'm not saying all therapists are bad, but I'd say that picking a therapist at random will have about as good of luck as picking a mechanic at random: Greater odds of your wallet being emptied than your problem being fixed. Finding an honest and talented practitioner is hard.
> Studies have demonstrated that treatment outcomes are not strongly correlated with clinicians' educational background
Isn't that a huge problem?
Imagine if that was the case for any other medical profession! "The surgical techniques we teach in school, and charge a lot of money and put students deep into debt for, aren't shown to be any better than someone coming off the street with a hacksaw and a really good smile."
Now that said, I've met people entering LMHC programs who obviously didn't need the credentials, their natural understanding of people was blatantly better than what 80% of their courses would cover. But those people are the obvious exception.
A giant % of therapists around my area advertise that their treatment methodology is "eclectic".
Trying to find someone who follows even CBT is almost impossible.
I have seen at least a few people advertising themselves as following Freudian principles. So there is that.
> Licensure is not all over the place.
The quality of programs that provides those licenses are. And thousands of hours of training under someone who is not very good, does not lead to a good practitioner.
I'm not saying all therapists are bad, but I'd say that picking a therapist at random will have about as good of luck as picking a mechanic at random: Greater odds of your wallet being emptied than your problem being fixed. Finding an honest and talented practitioner is hard.
> Studies have demonstrated that treatment outcomes are not strongly correlated with clinicians' educational background
Isn't that a huge problem?
Imagine if that was the case for any other medical profession! "The surgical techniques we teach in school, and charge a lot of money and put students deep into debt for, aren't shown to be any better than someone coming off the street with a hacksaw and a really good smile."
Now that said, I've met people entering LMHC programs who obviously didn't need the credentials, their natural understanding of people was blatantly better than what 80% of their courses would cover. But those people are the obvious exception.
pfft I like to ask every doc I go to, what outcomes they have produced in cases like mine and how many such cases they see a year. The CBT ppl just blink at me like the question is not on their manual. And one even said no great outcomes but here are the things you should do. Why would I spend my time doing them if they haven't produced results?
I mean these are nice people with good intentions but so is a priest in a church or a temple. The whole thing feels half baked. Ya ya I know reprogramming the mind is complex and this is a work in progress. But my experience from work and coaching team sports is people follow authority figures when in doubt/outcomes are unknown. And most shrinks and counsellors in my case atleast are unable to establish authority.
I mean these are nice people with good intentions but so is a priest in a church or a temple. The whole thing feels half baked. Ya ya I know reprogramming the mind is complex and this is a work in progress. But my experience from work and coaching team sports is people follow authority figures when in doubt/outcomes are unknown. And most shrinks and counsellors in my case atleast are unable to establish authority.
+1 I'm pretty sure multiple rounds of CBT made my anxiety disorders worse. The approach attracts hyper-rationalist types who aren't willing to say anything other than "Your thinking patterns are wrong, you need to fix them." No serious discussion of trauma, identity issues, or relationships. Pure gaslighting. Recently, I finally realized that what I needed was some serious introspection and an empathetic therapist who would help me work through it. For all the bluster about psychoanalysis being quackery, I'm not sure you can disagree with its basic premise that maladaptive personality traits are likely to come from the social context you spent most of your first ~18 years in.
Wouldn't many of your thinking patterns have come from your childhood and teenage years? How did none of this come up when you did CBT? Also, how did you do CBT without serious introspection? It sounds like the therapist you did CBT with just wasn't very good.
I've found that for my anxiety ERP based therapy is much more effective because often anxiety isn't a matter of your rational brains understanding but rather trained responses of your subconscious.
Outcomes are meaningless without control groups. The providers you spoke to may not have stunning reversals of illness to show you, but keeping someone from sliding into a worse state is an important function of therapy and impossible to measure. For all you know, they may have prevented dozens of suicides that year.
It's frustrting when you ask someone how they know this works or how effective it is and they give you blank looks. It feels like a failure of informed consent.
> The CBT ppl just blink at me like the question is not on their manual.
What country? In England the IAPT programme (the main source of CBT) has extensive data collection on outcomes (probably the largest collection in the world) and a focus on getting more and better evidence to improve the service.
Chapter 3 and 6 of the IAPT manual are about evidence based practice and gathering better data:
https://www.england.nhs.uk/wp-content/uploads/2018/06/the-ia...
The data sets are here: https://digital.nhs.uk/data-and-information/publications/sta...
The latest (Jun 12 2018) says this
---begin quote---
Key Facts
In April 2018 there were:
-- 119,304 new referrals;
-- 85,145 referrals that entered treatment;
-- 47,296 referrals that finished a course of treatment, of which;
-- 89.4 per cent waited less than 6 weeks and 98.9 per cent waited less than 18 weeks to enter treatment;
-- 44,222 started their treatment at caseness, with 51.9 per cent moving to recovery.
---end quote---
There's some jargon there, but that's explained in the executive summary: https://files.digital.nhs.uk/D3/B3FC5F/iapt-month-apr-2018-e...
tl;dr: CBT is somewhat effective; it's more effective if you have CBT that follows the high intensity model (14 to 20 weeks, one hour per week, face to face one to one with a qualified therapist).
> The CBT ppl just blink at me like the question is not on their manual.
What country? In England the IAPT programme (the main source of CBT) has extensive data collection on outcomes (probably the largest collection in the world) and a focus on getting more and better evidence to improve the service.
Chapter 3 and 6 of the IAPT manual are about evidence based practice and gathering better data:
https://www.england.nhs.uk/wp-content/uploads/2018/06/the-ia...
The data sets are here: https://digital.nhs.uk/data-and-information/publications/sta...
The latest (Jun 12 2018) says this
---begin quote---
Key Facts
In April 2018 there were:
-- 119,304 new referrals;
-- 85,145 referrals that entered treatment;
-- 47,296 referrals that finished a course of treatment, of which;
-- 89.4 per cent waited less than 6 weeks and 98.9 per cent waited less than 18 weeks to enter treatment;
-- 44,222 started their treatment at caseness, with 51.9 per cent moving to recovery.
---end quote---
There's some jargon there, but that's explained in the executive summary: https://files.digital.nhs.uk/D3/B3FC5F/iapt-month-apr-2018-e...
tl;dr: CBT is somewhat effective; it's more effective if you have CBT that follows the high intensity model (14 to 20 weeks, one hour per week, face to face one to one with a qualified therapist).
[deleted]
>And most shrinks and counsellors in my case atleast are unable to establish authority.
If you continuously end up in situations where you're seeing mental health professionals, you might consider just accepting their authority without the need to jump through your hoops.
If you continuously end up in situations where you're seeing mental health professionals, you might consider just accepting their authority without the need to jump through your hoops.
Speaking from experience, seems to me the GP’s need to make people jump through hoops to earn their trust is a damned important part of _why_ they need those professionals in the first place.
At a certain point you need to consider their success rate against your own. Realizing that and accepting they may be able to help is an important step.
For the most part, people see a psychotherapist because they've got problems that they feel unable to fix on their own. Awareness of resistance to the psychotherapeutic process is almost as old as psychotherapy - it's a central concept in Freudian psychoanalysis.
"You have to be willing to help yourself" is perilously close to "psychotherapy only works on people who are capable of changing of their own volition", which calls into question the entire purpose of psychotherapy. If I could change my way of thinking through sheer force of will, why would I pay a professional $100 an hour to sit and listen while I do it? It evokes the classic defence of the quack - the spoon only bends if you truly believe in the power of the mind.
If that problem is framed as "some patients are too sick to treat", then at least it shifts the burden of responsibility onto the therapist; it's not the patient's fault that the psychotherapist lacks the neccesary tools to facilitate change. Blaming the patient for having a bad attitude just makes the profession of psychotherapy look ineffectual.
"You have to be willing to help yourself" is perilously close to "psychotherapy only works on people who are capable of changing of their own volition", which calls into question the entire purpose of psychotherapy. If I could change my way of thinking through sheer force of will, why would I pay a professional $100 an hour to sit and listen while I do it? It evokes the classic defence of the quack - the spoon only bends if you truly believe in the power of the mind.
If that problem is framed as "some patients are too sick to treat", then at least it shifts the burden of responsibility onto the therapist; it's not the patient's fault that the psychotherapist lacks the neccesary tools to facilitate change. Blaming the patient for having a bad attitude just makes the profession of psychotherapy look ineffectual.
It's not really about being able to change yourself, it's about wanting to change so much that you're willing to put in the work. When I did it I had to unlearn a bunch of mental habits, but I also had to change my environment and seek things that were outside of what I knew. Therapy would have done nothing for me if I had let the therapist do all the work. I'm my case the work was to find a new way of living that is aligned with who I am and what I want for myself.
When I went in I had some major anxiety problems, and by working with my therapist I was able to identify where those problems came from. I started taking steps to change how I lived so I wasn't as anxious anymore.
When I went in I had some major anxiety problems, and by working with my therapist I was able to identify where those problems came from. I started taking steps to change how I lived so I wasn't as anxious anymore.
Blaming the patient for having a bad attitude just makes the profession of psychotherapy look ineffectual.
What sort of magic are you expecting from psychotherapy? You're paying someone to help you solve your problems. You're not paying someone to solve your problems for you.
What sort of magic are you expecting from psychotherapy? You're paying someone to help you solve your problems. You're not paying someone to solve your problems for you.
Modern advertising is based on psychology. It works surprisingly well even when people try to resist it.
Advertisers nudge you to do something you sort of already want to do. The amount of effort required to buy things is minimal and buying things you want to buy is usually enjoyable.
On the other hand, going to therapy is forcing yourself to do something that is difficult, sometimes painful and requires a lot of effort and resources (both time and money). I don't see the relationship between voluntarily going to therapy and advertising inducing you to buy things.
On the other hand, going to therapy is forcing yourself to do something that is difficult, sometimes painful and requires a lot of effort and resources (both time and money). I don't see the relationship between voluntarily going to therapy and advertising inducing you to buy things.
While it does require your participation for success, you are paying the professional for the tools to help yourself. And sometimes others aren’t able to help themselves, and the professional’s job is to help them discover how to.
Right — but it’s a pretty damn big first step. I can think of a fair few people who were never capable of taking that step
You can't help someone who doesn't want to help themselves.
I mean, if someone is shot, you can still surgically intervene without them having to participate. It’s true in psych that you have to help yourself, but it’s also true that’s probsbly a valid critique of the art rather than science that is psych. Talk therapy has more in common with spiritual guidance or shamanism than medicine, except where the actual medicine enters the fray in the form of drugs and surgery. If you’re willing to help yourself, talking to someone is often helpful, but that’s been known for thousands of years.
A real intervention doesn’t require someone to help themselves; an appendectomy doesn’t require patient participation and motivation.
A real intervention doesn’t require someone to help themselves; an appendectomy doesn’t require patient participation and motivation.
I mean, if someone is shot, you can still surgically intervene without them having to participate.
Okay, this is clearly not what we were talking about. Sorry I was not more specific in my statement to generalize to all scenarios, ever.
Edit: I think it is also a pretty fair assumption that if someone is shot or their appendix is about to burst, they would want help. The key difference here is that someone who is shot is not capable of helping themselves - with regards to many things people go to therapy for, the only way to fix your problems is going to be taking some actions yourself.
Okay, this is clearly not what we were talking about. Sorry I was not more specific in my statement to generalize to all scenarios, ever.
Edit: I think it is also a pretty fair assumption that if someone is shot or their appendix is about to burst, they would want help. The key difference here is that someone who is shot is not capable of helping themselves - with regards to many things people go to therapy for, the only way to fix your problems is going to be taking some actions yourself.
Consent is one thing “my appendix is killing me, help!” while actually doing the work yourself is another. Obviously any intervention requires consent to really work, but once you’ve consented to the appendectomy your role ends. You don’t have to actively engage in your own surgery past the act of wanting it. By contrast merely consenting to therapy isn’t enough, you have to do a lot of hard work as well. The fact that the hard work of everything from overcoming neuroses and anxieties to battling substance abuse is the patient doing the work suggests something about the nature of therapeutic intervention as “treatment” rather than advice-giving.
There’s a rub to all this in that all the good therapists are licensed, but not all licensed therapists are good. Anecdotally, therapy is at least as much art as it is science. There will always be those things that science cannot answer, that “logic” cannot provide a sufficient answer for. But yoga, meditation, art, dance, all these other things are also difficult to measure and quantify, and, we apply scientific rigor with various levels of failure to them.
How do you know someone has really meditated? You don’t. How do you know someone has had a good dance? You kinda don’t know that either.
There is a basis for understanding this from an engineering perspective, and it’s right there in what you just said — that outcomes are not correlated with educational background of the clinician. Sound like programming at all? Programming is also as much art as it is a science.
So therapy is no sure thing. That much, to me, is fine. And that’s the other rub. If you want to get something out of therapy, you’ll only get out as much as you get in. There can be no shortcuts blaming things you don’t like, nor idealizing the things you want to like. We can talk standards and rigor all day. But there’s no getting around having an internal compass of honesty, and a desire to apply that honesty to one’s life. That’s what a therapist (or therapy group) should be for you — an objective voice that questions your view of things while letting you be heard, as well as creating a safe environment for you to unwind the dark corners of the mind that are normally difficult to reflect upon on one’s own. Even there it is up to you to reflect on what happened afterwards. Your therapist cannot follow you all the way.
How do you know someone has really meditated? You don’t. How do you know someone has had a good dance? You kinda don’t know that either.
There is a basis for understanding this from an engineering perspective, and it’s right there in what you just said — that outcomes are not correlated with educational background of the clinician. Sound like programming at all? Programming is also as much art as it is a science.
So therapy is no sure thing. That much, to me, is fine. And that’s the other rub. If you want to get something out of therapy, you’ll only get out as much as you get in. There can be no shortcuts blaming things you don’t like, nor idealizing the things you want to like. We can talk standards and rigor all day. But there’s no getting around having an internal compass of honesty, and a desire to apply that honesty to one’s life. That’s what a therapist (or therapy group) should be for you — an objective voice that questions your view of things while letting you be heard, as well as creating a safe environment for you to unwind the dark corners of the mind that are normally difficult to reflect upon on one’s own. Even there it is up to you to reflect on what happened afterwards. Your therapist cannot follow you all the way.
Programming isn’t really a science, not because it is art, but because for a discipline to be a science it needs to be based on empirical evidence and “formal sciences” like math and computer science don’t pass the test.
Programming isn’t art either, not because you can’t do art via programming, of course you can, art happens whenever human hands are involved in the production process, my point being that we’ve romanticized programming for too long and it’s unhealthy.
Programming has more to do with engineering and plumbing than it does with sciences and art.
Programming isn’t art either, not because you can’t do art via programming, of course you can, art happens whenever human hands are involved in the production process, my point being that we’ve romanticized programming for too long and it’s unhealthy.
Programming has more to do with engineering and plumbing than it does with sciences and art.
The word you were looking for is "craft".
You listed a lot of specific licensed professions, titles, and degrees.
Across much of the US and Canada, words like "therapist" and "psychotherapist" are unregulated titles and practices, if not claimed to count as one of the licensed professions
I know for sure that this is true at least in New York where my mother is a (licensed PhD-holding) psychologist, and in Quebec where I live now, but I think this is typical.
"Psychologist" and "psychiatrist" are of course regulated, as is "social worker," but the generic unregulated therapy terms lead to lots of underqualified people doing bad diagnosis and treatment.
Across much of the US and Canada, words like "therapist" and "psychotherapist" are unregulated titles and practices, if not claimed to count as one of the licensed professions
I know for sure that this is true at least in New York where my mother is a (licensed PhD-holding) psychologist, and in Quebec where I live now, but I think this is typical.
"Psychologist" and "psychiatrist" are of course regulated, as is "social worker," but the generic unregulated therapy terms lead to lots of underqualified people doing bad diagnosis and treatment.
I am only familiar with the laws of OR, WA, MA, CA, and CO – the states where I'm considering doctoral programs – but "therapist" and "counsellor" are regulated and require one have a license to advertise with them. "Life coach" is the only title I am aware of that is completely unregulated across the US.
Psychoanalytical Therapist is perhaps the caveat you're thinking of? I know in New York it is a regulated title, and it may be possible to practice independently without a Counselling or Social Work degree provided one isn't billing insurance or advertising as a "psychotherapist".
Psychoanalytical Therapist is perhaps the caveat you're thinking of? I know in New York it is a regulated title, and it may be possible to practice independently without a Counselling or Social Work degree provided one isn't billing insurance or advertising as a "psychotherapist".
Here is NY's list of licensed professions: http://www.op.nysed.gov/prof/
Psychoanalyst is a regulated title, as are certain mental health professional titles which include the words therapist or counselor as part of the title.
But neither therapist or counselor standing alone nor psychotherapist is regulated there. (Nor is psychoanalytical therapist, unless something like case law has found that to be too confusingly similar to psychoanalyst.)
I'm not disputing your examples from other states. Just saying that these titles are significantly ambiguous across North America because of their inconsistent status, and therefore there's no standard of treatment which one can assume for them without knowing the precise state or province in question.
Psychoanalyst is a regulated title, as are certain mental health professional titles which include the words therapist or counselor as part of the title.
But neither therapist or counselor standing alone nor psychotherapist is regulated there. (Nor is psychoanalytical therapist, unless something like case law has found that to be too confusingly similar to psychoanalyst.)
I'm not disputing your examples from other states. Just saying that these titles are significantly ambiguous across North America because of their inconsistent status, and therefore there's no standard of treatment which one can assume for them without knowing the precise state or province in question.
In my home state Therapist is a regulated term, as is Counselor. There are two different licenses, LMHC and MFT with LMHC being a good indicator that you're not going to a quack. MFT does have some educational requirements but they're satisfied by religious vocational training. It was a helpful filter for me.
Good for you and I'm glad that you've got your condition under control.
But no amount of standards and licensing can help one who's slowly killing himself due to their conditons.
If anything, increased red tape will only raise prices and do nothing to the quality of help.
Source: own experience. $/hour never correlates to help/hour, and any regulation just drives $ up, no positive effect on help/$.
But no amount of standards and licensing can help one who's slowly killing himself due to their conditons.
If anything, increased red tape will only raise prices and do nothing to the quality of help.
Source: own experience. $/hour never correlates to help/hour, and any regulation just drives $ up, no positive effect on help/$.
You're saying you don't agree with standards and licensing in medical professions?
I say that in psychotherapy tighting up standards and licensing does not result in tangible benefits beyond a quite low threshold compared to other medical professions.
I think it's because no one knows shit wrt psychology, tons of books written nonwithstanding. It's all intuition. And those tons of books written which I read because I took my condition seriously only reinforce this opinion.
May the peace be with you. You don't want to take a look at the other side.
I think it's because no one knows shit wrt psychology, tons of books written nonwithstanding. It's all intuition. And those tons of books written which I read because I took my condition seriously only reinforce this opinion.
May the peace be with you. You don't want to take a look at the other side.
https://en.wikipedia.org/wiki/Dodo_bird_verdict
I don't know that there's convincing evidence that medically-certified talking is any more effective than any other talking (if that talking is without significant ulterior motive.) There is, however, evidence that talking about your problems helps. Therefore there is a case to be made that getting people talking about their issues is more important than the qualifications of the people they talk about those issues to. Hell, in 12-step programs and other support groups, people with similar problems just talking to each other clearly helps.
I don't know that there's convincing evidence that medically-certified talking is any more effective than any other talking (if that talking is without significant ulterior motive.) There is, however, evidence that talking about your problems helps. Therefore there is a case to be made that getting people talking about their issues is more important than the qualifications of the people they talk about those issues to. Hell, in 12-step programs and other support groups, people with similar problems just talking to each other clearly helps.
> Hell, in 12-step programs and other support groups, people with similar problems just talking to each other clearly helps.
I would take issue issue with the word "clearly", as there is controversy, at least according to Wikipedia (which you referenced). Perhaps "arguably" is a better word.
https://en.wikipedia.org/wiki/Twelve-step_program#Effectiven...
> It would be an error to assume the effectiveness of twelve-step methods at treating problems in one domain translates to all or to another domain, therefore readers are directed to relevant sections in each group's article.
[2] https://en.wikipedia.org/wiki/Effectiveness_of_Alcoholics_An...
> While newer studies have suggested an association between AA attendance and increased abstinence or other positive outcomes, older studies and studies done outside of the United States have not
I would take issue issue with the word "clearly", as there is controversy, at least according to Wikipedia (which you referenced). Perhaps "arguably" is a better word.
https://en.wikipedia.org/wiki/Twelve-step_program#Effectiven...
> It would be an error to assume the effectiveness of twelve-step methods at treating problems in one domain translates to all or to another domain, therefore readers are directed to relevant sections in each group's article.
[2] https://en.wikipedia.org/wiki/Effectiveness_of_Alcoholics_An...
> While newer studies have suggested an association between AA attendance and increased abstinence or other positive outcomes, older studies and studies done outside of the United States have not
There's what's called evidence based therapy.
Things like cognitive behavioral therapy and other methods.
Every therapist learns about it.
Nothing is 100% effective on every person. But on large groups it has statistically positive impacts on study vs control groups.
Things like cognitive behavioral therapy and other methods.
Every therapist learns about it.
Nothing is 100% effective on every person. But on large groups it has statistically positive impacts on study vs control groups.
There’s a reason there’s little agreement on standards for treatment or licensure. The only thing we have solid evidence helps in therapy/counselling/psychotherapy is a strong client therapist relationship, the therapeutic alliance. Up until recently the literature suggested cognitive behavioural therapy worked better than other schools but the case for that isn’t looking great lately either.
Therapy is hard and it only works if the client works at it. They can even work at it on their own, but they must work at it. Bibliotherapy, using a CBT workbook, works as well as a therapist if you actually do it but a therapist is an expensive means of ensuring you follow a programme.
> Is Professional Training Worth the Bother? A Review of the Impact of Psychotherapy Training on Client Outcome
> Abstract This article reviews the research literature on the effectiveness of paraprofessional counsellors and the impact of psychotherapy training on client outcome. Methodological and conceptual difficulties that have hampered previous research in this area are noted, and several well‐designed individual studies are highlighted. The existing evidence supports the efficacy of paraprofessional counsellors, although professional training may lead to better outcome in specific areas, such as greater client retention, briefer therapy, and better overall wellbeing for clients. However, methodological limitations of the research prohibit definitive conclusions. Guidelines for future research are offered.
Therapy is hard and it only works if the client works at it. They can even work at it on their own, but they must work at it. Bibliotherapy, using a CBT workbook, works as well as a therapist if you actually do it but a therapist is an expensive means of ensuring you follow a programme.
> Is Professional Training Worth the Bother? A Review of the Impact of Psychotherapy Training on Client Outcome
> Abstract This article reviews the research literature on the effectiveness of paraprofessional counsellors and the impact of psychotherapy training on client outcome. Methodological and conceptual difficulties that have hampered previous research in this area are noted, and several well‐designed individual studies are highlighted. The existing evidence supports the efficacy of paraprofessional counsellors, although professional training may lead to better outcome in specific areas, such as greater client retention, briefer therapy, and better overall wellbeing for clients. However, methodological limitations of the research prohibit definitive conclusions. Guidelines for future research are offered.
Here's what comes to my mind. There's this notion that if it isn't scientific it isn't serious. But if you want to take a scientific approach to everything, you won't be able to navigate life. If someone gives you personal advice on how to find a trustworthy contractor for your roof, do you demand a scientific study?
I'm not a scientist, so correct me if I'm wrong, but it seems that science is by far the best method of finding truth within pretty small parameters. A law of physics. The effects of one particular chemical on a certain kind of animal. Etc. For complicated things the best thing you can do is make a really simple model of it and draw a conclusion from that. The other details are anecdotes. Again, people say to avoid trusting anecdotes, but it's what we live by all the time day to day.
So when it comes to psychotherapy, it's an art form. Especially given the multiple incompatible schools of thought. It's not that much of a science. If a lot of people swear by it, well, maybe it's a placebo (though what would that even mean for psychotherapy?). Or maybe there's something to it for a decent number of people.
I'm not a scientist, so correct me if I'm wrong, but it seems that science is by far the best method of finding truth within pretty small parameters. A law of physics. The effects of one particular chemical on a certain kind of animal. Etc. For complicated things the best thing you can do is make a really simple model of it and draw a conclusion from that. The other details are anecdotes. Again, people say to avoid trusting anecdotes, but it's what we live by all the time day to day.
So when it comes to psychotherapy, it's an art form. Especially given the multiple incompatible schools of thought. It's not that much of a science. If a lot of people swear by it, well, maybe it's a placebo (though what would that even mean for psychotherapy?). Or maybe there's something to it for a decent number of people.
When it comes to health, yes, I prefer science. To me, that falls well within the same category as laws of physics, where the best method of finding truth is science.
Even picking a roofing contractor (or anything else that merely has to do with money or material possessions), I may not demand all the trappings of the scientific method, but, if possible, I want at least some of them, like data, and borrowing methodologies and reasoning. Relying on the advice/authority of a single other person is unappealing, unless I believe that other person actually did the research I would have done.
Sometimes, though, it's not possible. If a tree fell through the roof, it may not matter who the "best" one is, only the good-enough one available now.
Even picking a roofing contractor (or anything else that merely has to do with money or material possessions), I may not demand all the trappings of the scientific method, but, if possible, I want at least some of them, like data, and borrowing methodologies and reasoning. Relying on the advice/authority of a single other person is unappealing, unless I believe that other person actually did the research I would have done.
Sometimes, though, it's not possible. If a tree fell through the roof, it may not matter who the "best" one is, only the good-enough one available now.
One could cut much deeper: No accepted view of what the mind and consciousness really are, no model for the mind, no accepted view of 'what normal is', and no real way to truly identify and diagnose most supposed disorders.
For things like schizophrenia maybe we can help.
But for things like 'depression' we're still walking around in the dark, notwithstanding good progress on some specific things.
For things like schizophrenia maybe we can help.
But for things like 'depression' we're still walking around in the dark, notwithstanding good progress on some specific things.
I don't see the fundamental difference between schozophrenia and depression in terms of why one is more or less valid as a target for treatment.
Their point was not that one is less valid than the other as a target for treatment but that we have a slightly better grasp of depression’s etiology than schizophrenia’s.
I’d argue that A. and B. aren’t necessarily problems. After all, if it’s hard to quantify and empirically measure, wouldn’t the hypothetical standards be arbitrary?
I’ll speak from personal experience: the most effective psychotherapy treatment I’ve received is very “unconventional,” with emphases on philosophy, meditation, and physical activity in nature. Those experiences have hugely impacted me in positive ways.
When an entity doesn’t know how to standardize or effectively certify, but does so anyway, we get quack systems as a result.
I’ll speak from personal experience: the most effective psychotherapy treatment I’ve received is very “unconventional,” with emphases on philosophy, meditation, and physical activity in nature. Those experiences have hugely impacted me in positive ways.
When an entity doesn’t know how to standardize or effectively certify, but does so anyway, we get quack systems as a result.
How'd you go about finding such a form of treatments?
A1. Independently of their efficacy, each school's explanations of how their therapy approach works range from plausible-but-unproven (some aspects of some CBT approaches) to blatant pseudoscience (EMDR, psychoanalysis). Many constructs used to describe personality and behavior are little more than ad hoc descriptions with no grounding in a more general theory.
This is also true for many other branches of medicine.
Many explanations of medical issues and treatments lack accuracy or explanatory power, sure. Doctors disagree all the time on diagnosis and treatment. But in psychotherapy it's like having a neurologist tell you that your diabetes is caused by compression of a lumbar nerve while a gastroenterologist tells you that it's caused by an intestinal obstruction.
I'm a tenured professor of clinical psychology who doesn't focus on therapy in research, but who does focus on meta-analysis.
A. This either true or not true depending on how you look at it. There are standards of treatment, but the differential evidence in favor of any given treatment is usually poor except in some cases so it is difficult to justify any particular approach. There is no reason to mandate a specific treatment from a licensed professional if there's no strong evidence in favor of it over any other.
B. Licensing requirements are all over the place, but in some ways they are overly stringent. The licensing requirements per se aren't the problem, they're the admitting standards of certain programs, and the abuses of for-profit degree programs, which can actually be quite predatory. By the time a psychologist is licensed, the level of clinical training experience required by most states is probably equivalent to a psychiatrist. Many psychologists with bio backgrounds from reputable PhD programs (note many of these students do neuroscience or genetics research of some sort) have the odd experience at a particular point in their careers of being unlicensed but being more familiar with psychiatric issues (including drugs) than first or second-year psychiatry residents.
The meta-analysis in this piece is interesting, but not novel. Similar things have been shown in other meta-analyses in the past.
If you asked me to summarize the literature on therapy from a meta-analytic perspective, this is what I would say:
There is strong evidence that therapy is effective, from all sorts of randomized controlled designs with all sorts of controls (behavioral, pharmeceutical controls of all sorts).
There is little evidence of differential efficacy between therapies overall. This means that, e.g., there is no real evidence that CBT is more efficacious than psychodynamic therapy, despite what you might think or have been told. There is some evidence that for very specific targeted outcomes (e.g., reduction of a particular type of behavior), some therapies are better, but not for general outcomes.
There is evidence of publication bias. If you adjust for this, the positive effect of therapy does not go away, but it does reinforce the lack of differential efficacy. CBT and behavioral studies as a literature show the largest publication bias in previous second-order meta-analyses. (I want to point out that drug therapies also have problems with publication bias, as do all sorts of other scientific studies. This is a problem with science at the moment.)
The effect of individual therapist dwarfs that of therapy type. That is, there is strong evidence that there are very good therapists, but we don't really understand what they are doing.
There is some evidence that therapist-client match and cohesiveness, is important. So if you don't feel like things are working with your therapist, try a different approach. Incidentally, this is also true of drugs; trials show that people might fail with one drug but succeed with another.
I want to point out that treating (or hell, assessing and measuring) mental illness is a difficult problem, regardless of how you approach it. The ambiguities in the field are not because people are just stupid. There are very intelligent people who have been working on these things from many angles, and things are complicated and multilayered, from genes to social systems. Many good ideas just don't work, or don't work the way you'd think.
A. This either true or not true depending on how you look at it. There are standards of treatment, but the differential evidence in favor of any given treatment is usually poor except in some cases so it is difficult to justify any particular approach. There is no reason to mandate a specific treatment from a licensed professional if there's no strong evidence in favor of it over any other.
B. Licensing requirements are all over the place, but in some ways they are overly stringent. The licensing requirements per se aren't the problem, they're the admitting standards of certain programs, and the abuses of for-profit degree programs, which can actually be quite predatory. By the time a psychologist is licensed, the level of clinical training experience required by most states is probably equivalent to a psychiatrist. Many psychologists with bio backgrounds from reputable PhD programs (note many of these students do neuroscience or genetics research of some sort) have the odd experience at a particular point in their careers of being unlicensed but being more familiar with psychiatric issues (including drugs) than first or second-year psychiatry residents.
The meta-analysis in this piece is interesting, but not novel. Similar things have been shown in other meta-analyses in the past.
If you asked me to summarize the literature on therapy from a meta-analytic perspective, this is what I would say:
There is strong evidence that therapy is effective, from all sorts of randomized controlled designs with all sorts of controls (behavioral, pharmeceutical controls of all sorts).
There is little evidence of differential efficacy between therapies overall. This means that, e.g., there is no real evidence that CBT is more efficacious than psychodynamic therapy, despite what you might think or have been told. There is some evidence that for very specific targeted outcomes (e.g., reduction of a particular type of behavior), some therapies are better, but not for general outcomes.
There is evidence of publication bias. If you adjust for this, the positive effect of therapy does not go away, but it does reinforce the lack of differential efficacy. CBT and behavioral studies as a literature show the largest publication bias in previous second-order meta-analyses. (I want to point out that drug therapies also have problems with publication bias, as do all sorts of other scientific studies. This is a problem with science at the moment.)
The effect of individual therapist dwarfs that of therapy type. That is, there is strong evidence that there are very good therapists, but we don't really understand what they are doing.
There is some evidence that therapist-client match and cohesiveness, is important. So if you don't feel like things are working with your therapist, try a different approach. Incidentally, this is also true of drugs; trials show that people might fail with one drug but succeed with another.
I want to point out that treating (or hell, assessing and measuring) mental illness is a difficult problem, regardless of how you approach it. The ambiguities in the field are not because people are just stupid. There are very intelligent people who have been working on these things from many angles, and things are complicated and multilayered, from genes to social systems. Many good ideas just don't work, or don't work the way you'd think.
> also have problems with publication bias, as do all sorts of other scientific studies. This is a problem with science at the moment
There is also the "reproducibility crisis" which can be very closely related to publication bias, since a reproduced result may be even less remarkable than a negative result.
> The ambiguities in the field are not because people are just stupid. There are very intelligent people who have been working on these things
At the risk of sounding flippant, I am reminded of the {Forrest Gump} quote "Stupid is as stupid does" (which is, of course, an update of earlier aphorisms with similar meaning).
To whit, in light of all the well-understood, self-admitted, fundamental problems with science at the moment, that are at least partially due to the behavior of the participants, at what point is the innate intelligence of those participants no longer a defense against an accusation of "just stupid"?
There is also the "reproducibility crisis" which can be very closely related to publication bias, since a reproduced result may be even less remarkable than a negative result.
> The ambiguities in the field are not because people are just stupid. There are very intelligent people who have been working on these things
At the risk of sounding flippant, I am reminded of the {Forrest Gump} quote "Stupid is as stupid does" (which is, of course, an update of earlier aphorisms with similar meaning).
To whit, in light of all the well-understood, self-admitted, fundamental problems with science at the moment, that are at least partially due to the behavior of the participants, at what point is the innate intelligence of those participants no longer a defense against an accusation of "just stupid"?
In addition you have that the research is not nearly as careful as pharmaceuticals and even they run into tons of issues.
I’ve wondered for a long time about crowdsourced “therapy” — a kind of it, anyway.
I don’t want to just hear myself talk for an hour, which is usually what therapy amounts to for me anyway. I want other perspectives. I want to hear other people whove been through what I’ve been through talking deeply and honestly about their lives. And I want enough perspectives that I can figure out for myself what modes of thinking, strategies, etc, I might make the most use of.
The problem is most people are incredibly closed. Myself included. We don’t talk about our internal mental life as it relates to the outside world. Well, we do - but not with much transparency. And we don’t talk about our personal histories, our childhoods, our teenage years, etc. We don’t talk about the intimate details of our lives.
(And we really shouldn’t; to be clear. Not in a way that can be traced back to us. Much of personal histories are deeply embarrassing.)
And yet, we’re supposed to figure out on our own what’s normal and what isn’t.
I feel like I’ve spent literally years learning things that other people figured out a long time ago.
I’ve been thinking for a while about making a website that’s 100% anonymous (but moderated), but encourages people to write honestly about their own lives.
No advice. It wouldn’t be about advice. It’d be only a repository of individual experiences.
I feel like such a site, if done well, could be a real boon to people who are struggling to figure out life, as I was.
I don’t want to just hear myself talk for an hour, which is usually what therapy amounts to for me anyway. I want other perspectives. I want to hear other people whove been through what I’ve been through talking deeply and honestly about their lives. And I want enough perspectives that I can figure out for myself what modes of thinking, strategies, etc, I might make the most use of.
The problem is most people are incredibly closed. Myself included. We don’t talk about our internal mental life as it relates to the outside world. Well, we do - but not with much transparency. And we don’t talk about our personal histories, our childhoods, our teenage years, etc. We don’t talk about the intimate details of our lives.
(And we really shouldn’t; to be clear. Not in a way that can be traced back to us. Much of personal histories are deeply embarrassing.)
And yet, we’re supposed to figure out on our own what’s normal and what isn’t.
I feel like I’ve spent literally years learning things that other people figured out a long time ago.
I’ve been thinking for a while about making a website that’s 100% anonymous (but moderated), but encourages people to write honestly about their own lives.
No advice. It wouldn’t be about advice. It’d be only a repository of individual experiences.
I feel like such a site, if done well, could be a real boon to people who are struggling to figure out life, as I was.
I built a platform for myself to think about life's deepest questions, and I've been going around asking people their questions.
On my business cards are different set of questions, and here are some of the answers
https://www.deepthoughtapp.com/packages/189/business-cards-i...
So far I have 50,000+ questions, 3,600+ answers (mostly mine)
The platform isn't about advice, it's about people answering the deep questions to themselves.
On my business cards are different set of questions, and here are some of the answers
https://www.deepthoughtapp.com/packages/189/business-cards-i...
So far I have 50,000+ questions, 3,600+ answers (mostly mine)
The platform isn't about advice, it's about people answering the deep questions to themselves.
Online forums are great for this. At various points in my life I've spent times on forums which provided exactly what you're talking about - a chance to talk openly and anonymously with other people who've faced the same challenges.
There can be no real connection without showing your own wounds.
Your wounds also heal when you look into the eyes of another human telling you their fear and trauma with tears in their eyes. You connect with the experience of very humbling and deep empathy as the pain and feelings you share are the same. They are universal. You are not separate and you become to understand that you were never broken or incomplete or different.
This is the power of sharing yourself with others. We are not here alone and were never supposed to figure thins out alone.
Your wounds also heal when you look into the eyes of another human telling you their fear and trauma with tears in their eyes. You connect with the experience of very humbling and deep empathy as the pain and feelings you share are the same. They are universal. You are not separate and you become to understand that you were never broken or incomplete or different.
This is the power of sharing yourself with others. We are not here alone and were never supposed to figure thins out alone.
How would this help you, though? I would think for therapy to work, you have to go through the process of challenging your own unhelpful thoughts and beliefs and then act in a way to reinforce new thoughts and beliefs which are more useful. The therapist is someone who knows which questions to ask to help you with the first part (as well as provide emotional support), but the second part has to be done 100% by yourself. This is a very difficult thing to do. Just reading about other people's life challenges may help motivate you a little bit, but otherwise the hardest part is making the change yourself.
There is a group model similar to what you describe called DBT, and it's a standard treatment for borderline personality disorder. It's been around for decades. It seems to be useful for many conditions.
I have undergone CBT with 5 therapists and so I am quite experienced with it. Every time I have been left completely and utterly disappointed.
One of the unfortunate problems I faced with psychotherapy was the convenient shift of outcome being dependent on the quality of care given by the therapist to the mental fortitude of the patient following through on their exercises. In every case it was my fault that I wasn't progressing, and I found this to be extremely frustrating.
It would go something like "Did your CBT methods help you not have a panic attack?", "No they didn't work and I threw up and collapsed in a Starbucks bathroom". "Oh well just practice more and identify those bad thoughts better and earlier and do some more breathing exercises and it will work out fine!"
My very last encounter with psychotherapy is when I went to a doctor and explained that CBT doesn't work for me and that I was looking for someone else who practiced other methods, and yet again they claimed that I needed more practice and that I probably had not mastered CBT. Although we don't practice lobotomies anymore, if you have severe issues mental health treatment is still in the stone age.
One of the unfortunate problems I faced with psychotherapy was the convenient shift of outcome being dependent on the quality of care given by the therapist to the mental fortitude of the patient following through on their exercises. In every case it was my fault that I wasn't progressing, and I found this to be extremely frustrating.
It would go something like "Did your CBT methods help you not have a panic attack?", "No they didn't work and I threw up and collapsed in a Starbucks bathroom". "Oh well just practice more and identify those bad thoughts better and earlier and do some more breathing exercises and it will work out fine!"
My very last encounter with psychotherapy is when I went to a doctor and explained that CBT doesn't work for me and that I was looking for someone else who practiced other methods, and yet again they claimed that I needed more practice and that I probably had not mastered CBT. Although we don't practice lobotomies anymore, if you have severe issues mental health treatment is still in the stone age.
I've undergone CBT too and it always felt like quackery to me. The point of CBT seems to be to get people to accept their shitty circumstances instead of actually fixing things. Psychology is the new religion. Instead of saying "accept your shitty life, you'll be rewarded after death" they are saying "you think you have a shitty life, but you just need to look at it differently".
CBT felt like an exercise in self-deception to me. The 'bad thoughts' are a result of the shitty circumstances in life, so shouldn't we be working on those instead of trying to convince myself that shit doesn't stink ?
I strongly believe that 99% of people who visit a psychiatrist could be cured by just handing them 20 million dollars. That would return a persons freedom and remove a huge amount of stress-factors.
CBT felt like an exercise in self-deception to me. The 'bad thoughts' are a result of the shitty circumstances in life, so shouldn't we be working on those instead of trying to convince myself that shit doesn't stink ?
I strongly believe that 99% of people who visit a psychiatrist could be cured by just handing them 20 million dollars. That would return a persons freedom and remove a huge amount of stress-factors.
Given how miserable lottery winners are, or how many wealthy people are in therapy, it doesn’t seem like cash solves people’s mental health problems. If anything, it can exacerbate them.
CBT felt like an exercise in self-deception to me.
And what makes you think your current perception of the world is completely perfect and unbiased? Perhaps the problem is that you are convinced that you have the most accurate picture of the world and aren't questioning it.
And what makes you think your current perception of the world is completely perfect and unbiased? Perhaps the problem is that you are convinced that you have the most accurate picture of the world and aren't questioning it.
To give you an example: Having to work for a living is beyond horrible. I have to spend the majority of my life slaving away just struggling to survive in a world I never chose to be a part of.
I can 'change my perception' of this, but no matter how I change my perception it won't give me my freedom. CBT's goal seems to be denying the problem instead of trying to fix it and convincing people this shit doesn't stink.
I can 'change my perception' of this, but no matter how I change my perception it won't give me my freedom. CBT's goal seems to be denying the problem instead of trying to fix it and convincing people this shit doesn't stink.
Perhaps you need to dig deeper to figure out what exactly it is about working for a living that you hate so much. If it just happens to be "all of it", what would you be doing instead if you didn't work?
Edit: I should also mention that I too work for a living and I enjoy it for the most part. I get paid to work on interesting problems and spend time with coworkers who I like. There are annoying things but overall it's a net positive in my life. So I know, given my own experience, that it is absolutely possible to just enjoy working for a living.
Edit: I should also mention that I too work for a living and I enjoy it for the most part. I get paid to work on interesting problems and spend time with coworkers who I like. There are annoying things but overall it's a net positive in my life. So I know, given my own experience, that it is absolutely possible to just enjoy working for a living.
I hate the fact that I can’t use my limited time on this planet as I see fit. I like the work I do but I hate that i have to do it.
> what would you be doing instead if you didn't work?
Whatever I feel like doing at the time.
> what would you be doing instead if you didn't work?
Whatever I feel like doing at the time.
Confused. Nobody is 'holding a gun to your head'. So don't work?
Oh! The money is sweet. Now we're starting to understand. Money is needed to get resources from other people, in order to do those sweet things that we 'feel like' doing.
So the work resentment seems simply to be a rather primitive envy, to have things without making them or working for them.
Oh! The money is sweet. Now we're starting to understand. Money is needed to get resources from other people, in order to do those sweet things that we 'feel like' doing.
So the work resentment seems simply to be a rather primitive envy, to have things without making them or working for them.
> in order to do those sweet things that we 'feel like' doing
You mean like not dying ? So basically, it's work or die. We have a word for that, it's called slavery. But wait, in our capitalist system I get to choose my own slavedriver, wow, that changes everything... NOT.
If you get a dog, you're expected to take care of that dog for it's entire life. Yet, if you produce a child it's somehow acceptable to abandon it after 18 years and expect it to take care of itself. It never asked to be born, yet it has to deal with the financial consequences of a decision someone else made. It's like taking an 80+ year mortgage and expecting someone else to pay for it after 18 years.
If you're going to have kids, you should take care of them for their entire lives.
You mean like not dying ? So basically, it's work or die. We have a word for that, it's called slavery. But wait, in our capitalist system I get to choose my own slavedriver, wow, that changes everything... NOT.
If you get a dog, you're expected to take care of that dog for it's entire life. Yet, if you produce a child it's somehow acceptable to abandon it after 18 years and expect it to take care of itself. It never asked to be born, yet it has to deal with the financial consequences of a decision someone else made. It's like taking an 80+ year mortgage and expecting someone else to pay for it after 18 years.
If you're going to have kids, you should take care of them for their entire lives.
Then what do you do when your parents die? And someone else is supposed to take care of your parents while they are taking care of you? At some point, people need to take care of themselves. Maybe some aren't ready at 18 to be out there on their own, but you need to take responsibility for your own life at some point.
On a related note, you should know that depression causes cognitive distortions. You should really take a look at this if you haven't seen it already: https://en.wikipedia.org/wiki/Beck%27s_cognitive_triad
Do you find people often disagree with your views on life? Is it possible that your reasoning is potentially being made on imperfect information since depression filters out all the positive aspects of everything?
On a related note, you should know that depression causes cognitive distortions. You should really take a look at this if you haven't seen it already: https://en.wikipedia.org/wiki/Beck%27s_cognitive_triad
Do you find people often disagree with your views on life? Is it possible that your reasoning is potentially being made on imperfect information since depression filters out all the positive aspects of everything?
> Then what do you do when your parents die?
The money should be there (e.g. in a trust fund) before conception.
> And someone else is supposed to take care of your parents while they are taking care of you?
Yes, their parents, obviously.
Nothing really changes relative to now for people who want to reproduce, instead of paying for themselves they pay for their children. Only people who are childfree benefit, which is a nice incentive to reduce the population.
> you need to take responsibility for your own life at some point
No, I do not. I didn't create this life, how can I be responsible for it ?
> On a related note, you should know that depression causes cognitive distortions.
https://en.wikipedia.org/wiki/Depressive_realism
The money should be there (e.g. in a trust fund) before conception.
> And someone else is supposed to take care of your parents while they are taking care of you?
Yes, their parents, obviously.
Nothing really changes relative to now for people who want to reproduce, instead of paying for themselves they pay for their children. Only people who are childfree benefit, which is a nice incentive to reduce the population.
> you need to take responsibility for your own life at some point
No, I do not. I didn't create this life, how can I be responsible for it ?
> On a related note, you should know that depression causes cognitive distortions.
https://en.wikipedia.org/wiki/Depressive_realism
Sigh, well if you really want to be depressed, I suppose it's a free country. Speaking as someone who used to be depressed, all that depressive realism stuff is total BS. When you completely filter out all the positive aspects of everything and focus on the negative only, you're just not seeing the complete picture.
I’m not depressed though.
My own experiences with depression have made me think you’re both partially correct.
I feel like happiness is about learning how to deceive yourself. It’s about learning how to put a positive spin on everything, and internalise it.
I struggle with this because I don’t want to deceive myself. But then I’m probably deceiving myself in the opposite direction with all sorts of negative thoughts.
I feel like happiness is about learning how to deceive yourself. It’s about learning how to put a positive spin on everything, and internalise it.
I struggle with this because I don’t want to deceive myself. But then I’m probably deceiving myself in the opposite direction with all sorts of negative thoughts.
Personally, I have found it helps to just always try to take a pragmatic perspective: how is what I'm doing right now helping me achieve what I want in life? If you spend an hour thinking about how you suck at various aspects of your life, how is it making you feel? When you feel that way, are you in the best state of mind to achieve your goals? Absolutely not. So you need strategies to deal with those useless thoughts. Distract yourself with something else or reframe your thinking somehow. In the long run, the ideal would be to not have those unhelpful automatic thoughts at all (this is what therapy is for) but in the short run, they are there and you gotta find a way to deal with and manage them if you want to move your life forward. Meditation/mindfulness can be extremely helpful in this regard. I'd highly recommend "The Mindful Way Through Depression" to learn some techniques to help. The goal here should be to catch yourself sooner when you're thinking unhelpful thoughts instead of marinating in them for a long period of time (and creating a more negative effect on your mood) and learning a strategy to get out of that mode of thinking.
> If you spend an hour thinking about how you suck at various aspects of your life, how is it making you feel?
It doesn't matter how you feel about it. You need to focus on the bad things in life if you want to have a chance of improving things. Burying your head in the sand doesn't solve anything. Don't waste your time focussing on the good stuff, it doesn't need fixing.
If all you want to do is feel good despite everything around you being shit, why not just do heroin ? You'll feel great and it's a lot less effort than convincing yourself that black is white.
It doesn't matter how you feel about it. You need to focus on the bad things in life if you want to have a chance of improving things. Burying your head in the sand doesn't solve anything. Don't waste your time focussing on the good stuff, it doesn't need fixing.
If all you want to do is feel good despite everything around you being shit, why not just do heroin ? You'll feel great and it's a lot less effort than convincing yourself that black is white.
How is it that how you feel about yourself does not matter? It matters quite a bit. I also never said to bury your head in the sand and not improve anything? What I am saying is actually the exact opposite of that. Let me give an example: suppose you wanted to get in shape by going to the gym. You can sit around and think "I'm so out of shape", "I'm going to embarrass myself at the gym", "I won't be able to keep it up", etc. None of this is helping you with your original goal, which is going to the gym and getting in shape. Not only that, these thoughts are driving your mood down and making it less likely you will follow through on your plans, not more likely. These are the exact type of thoughts which depressed people deal with every single day. You can't just force them to stop occurring whenever you want, this is just what depression is. The ideal would be to change whatever core beliefs and assumptions are leading to these thoughts, but making that change with therapy can take a very long time. What you can do is take a more proactive approach early on to recognize these thoughts when they occur and deal with them every single time they come up (which will depend on how depressed you are). This may not stop the thoughts from occurring but you will have a strategy to keep yourself from self-defeating behavior.
> You can sit around and think "I'm so out of shape", "I'm going to embarrass myself at the gym", "I won't be able to keep it up", etc. None of this is helping you with your original goal
But they are true though. If it’s a choice between being miserable and acknowledging the truth, or being happy in a delusion of your own making, I’ll choose the truth every time.
I think people are being labelled as depressed way too often. In many cases it’s just a natural reaction to having a shit life. Anyone would feel like crap, it’s perfectly normal. The solution is to fix your life, not to convince youself nothing is wrong. If you don’t manage to delude yourself, if you see the world as it actually is, you get labelled as ‘depressed’. It’s not because you have to work 2 minimum wage jobs to make ends meet that you feel like crap, no something is wrong with YOU. CBT is basically a form of victim blaming.
But they are true though. If it’s a choice between being miserable and acknowledging the truth, or being happy in a delusion of your own making, I’ll choose the truth every time.
I think people are being labelled as depressed way too often. In many cases it’s just a natural reaction to having a shit life. Anyone would feel like crap, it’s perfectly normal. The solution is to fix your life, not to convince youself nothing is wrong. If you don’t manage to delude yourself, if you see the world as it actually is, you get labelled as ‘depressed’. It’s not because you have to work 2 minimum wage jobs to make ends meet that you feel like crap, no something is wrong with YOU. CBT is basically a form of victim blaming.
You are very confused. I'm not saying those things aren't true. I'm saying they are just unhelpful. I'm not saying to delude yourself by saying "Actually, I am in shape", "I will never embarrass myself at the gym" or "I'll be able to keep this up forever". I'm saying, think more productive thoughts that will get you closer to your goal. For example, you say to yourself "I'm so out of shape. I hate how I look". What you want to do is catch yourself and ask "How are these thoughts helping me get in better shape?". They aren't. They are only hurting you. Going to the gym and working out is what will get you in shape, regardless of whether your thoughts are positive or negative. But thinking negatively all the time will sap your motivation and enjoyment of life.
Edit: I also want to acknowledge this:
If it’s a choice between being miserable and acknowledging the truth, or being happy in a delusion of your own making
There are clearly other choices here that you are missing:
- Think about something else that is not going to make you feel miserable. Take your dog for a walk, listen to some music you like, meditate. Relax, enjoy life.
- Reframe your negative thoughts. For example, if I think "I'm going to embarrass myself at the gym, I might as well not go". A way to reframe this is "so what if I embarrass myself at the gym? I'm not an expert at lifting weights and working out and that is plainly clear by me being out of shape. If someone else doesn't like what I'm doing or the way I look, that is their problem. I'm trying to do something good for myself here and I'm not going to let other people get in my way".
- Stop thinking your negative thought and make an action plan to fix it. For example "I'm so fat and out of shape". This will make you feel shitty for a brief period of time, but writing down a real plan that you can do to resolve the problem will make you feel better. The plan has to be doable. A lot of people make huge plans that are very difficult to execute. To make a doable plan to resolve a problem, you first may need to break the problem down in to smaller chunks. Also, it is important to remember that it doesn't matter if someone else was able to accomplish the same thing you're trying to do with less effort. The only thing that should matter to you is getting the results you want.
- Tell yourself to worry about the problem later. Again, "I'm going to embarrass myself at the gym". Is this really a problem for you right now if you're not planning to go to the gym until tomorrow? It is not a problem for right now. Shelf it for later and do something right now that can make your life better.
- Question your thought. Back to embarrassing yourself at the gym. You're making an assumption that the fit people at the gym are going to see an overweight person doing something incorrect and they will ridicule you for it. In reality, it is very likely that some of those people in the gym were once in your shoes, overweight and down on themselves and lost as to what to do. It is perhaps equally likely that someone will see your efforts and come over and offer you encouragement and advice. You may even make some friends.
- One last thing can just be to accept the thought as reality and move on. The thought: "I won't be able to keep this up forever". Well, that is probably true, but does that mean you shouldn't try? Do you respect people who quit before they've even started? Your own internal response to this should be "I can't keep it up forever, but I can try my best because that is the type of person I want to be" and leave it at that. And you may even be wrong. Maybe you can keep going to the gym until you're 80. Or another thing to ask is if this thought even matters? Your goal is just to get in shape in the near future, not have a six pack in your 80s.
Edit: I also want to acknowledge this:
If it’s a choice between being miserable and acknowledging the truth, or being happy in a delusion of your own making
There are clearly other choices here that you are missing:
- Think about something else that is not going to make you feel miserable. Take your dog for a walk, listen to some music you like, meditate. Relax, enjoy life.
- Reframe your negative thoughts. For example, if I think "I'm going to embarrass myself at the gym, I might as well not go". A way to reframe this is "so what if I embarrass myself at the gym? I'm not an expert at lifting weights and working out and that is plainly clear by me being out of shape. If someone else doesn't like what I'm doing or the way I look, that is their problem. I'm trying to do something good for myself here and I'm not going to let other people get in my way".
- Stop thinking your negative thought and make an action plan to fix it. For example "I'm so fat and out of shape". This will make you feel shitty for a brief period of time, but writing down a real plan that you can do to resolve the problem will make you feel better. The plan has to be doable. A lot of people make huge plans that are very difficult to execute. To make a doable plan to resolve a problem, you first may need to break the problem down in to smaller chunks. Also, it is important to remember that it doesn't matter if someone else was able to accomplish the same thing you're trying to do with less effort. The only thing that should matter to you is getting the results you want.
- Tell yourself to worry about the problem later. Again, "I'm going to embarrass myself at the gym". Is this really a problem for you right now if you're not planning to go to the gym until tomorrow? It is not a problem for right now. Shelf it for later and do something right now that can make your life better.
- Question your thought. Back to embarrassing yourself at the gym. You're making an assumption that the fit people at the gym are going to see an overweight person doing something incorrect and they will ridicule you for it. In reality, it is very likely that some of those people in the gym were once in your shoes, overweight and down on themselves and lost as to what to do. It is perhaps equally likely that someone will see your efforts and come over and offer you encouragement and advice. You may even make some friends.
- One last thing can just be to accept the thought as reality and move on. The thought: "I won't be able to keep this up forever". Well, that is probably true, but does that mean you shouldn't try? Do you respect people who quit before they've even started? Your own internal response to this should be "I can't keep it up forever, but I can try my best because that is the type of person I want to be" and leave it at that. And you may even be wrong. Maybe you can keep going to the gym until you're 80. Or another thing to ask is if this thought even matters? Your goal is just to get in shape in the near future, not have a six pack in your 80s.
- "But thinking negatively all the time will sap your motivation and enjoyment of life."
The thing is that people are not always embarrassed, because they like to feel embarrassed. You'll get comments, snarky, clever remarks that will stick in your head. You'll get people staring at you, pointing at you, laughing behind your back just in earshot. They'll twist the truth, saying your lazy or dimwitted. Those things make you feel negative too. Now you'll say, "but you got to break the vicious cycle!", but that's so easy to say. Even if you've been through the same, your experience is completely different. People get depressed because they see the work ahead to break out of that circle, and if it's big enough they start to contemplate their existence in life. Because at some point you'll learn, that after breaking this vicious cycle, there's a next, and a next. And the reward is often too small. It also definitely doesn't help that some people have it easier only because of sheer luck, and those same people will be the ones keeping you down - "where you belong".
Edit: For the record, I also think CBT sucks
The thing is that people are not always embarrassed, because they like to feel embarrassed. You'll get comments, snarky, clever remarks that will stick in your head. You'll get people staring at you, pointing at you, laughing behind your back just in earshot. They'll twist the truth, saying your lazy or dimwitted. Those things make you feel negative too. Now you'll say, "but you got to break the vicious cycle!", but that's so easy to say. Even if you've been through the same, your experience is completely different. People get depressed because they see the work ahead to break out of that circle, and if it's big enough they start to contemplate their existence in life. Because at some point you'll learn, that after breaking this vicious cycle, there's a next, and a next. And the reward is often too small. It also definitely doesn't help that some people have it easier only because of sheer luck, and those same people will be the ones keeping you down - "where you belong".
Edit: For the record, I also think CBT sucks
I think what it comes down to is self compassion - you have to care about yourself, especially if you believe no one else does. This is something that doesn't just happen. You have to practice self compassion and do things for yourself. Another approach to build some self compassion is loving kindness meditation. Once you have some self compassion you can forgive yourself for some of your own faults. As you said, some of us are lucky and some of us are unlucky. Just like it's not the fault of the lucky people that they had good luck, it too is not your fault you had bad luck. Best not to dwell on what you can't have - all you do is torture yourself for no reason - and just focus on what you can have.
Edit: regarding what other people think, it is best to just focus on what you know to be true and challenge anything that could be potentially untrue. If someone ridicules you, they're a jerk. But don't engage in any sort of mind reading exercises. It is pointless torture. Focus on what you want for yourself and don't let other people's opinions distract you from your goal.
Edit: regarding what other people think, it is best to just focus on what you know to be true and challenge anything that could be potentially untrue. If someone ridicules you, they're a jerk. But don't engage in any sort of mind reading exercises. It is pointless torture. Focus on what you want for yourself and don't let other people's opinions distract you from your goal.
You're right of course, and this is something I've recently began to learn for myself (thanks for re-asserting). I just think this is a very difficult lesson to learn, since it goes so much against our social instincts (as humans).
No, you don't have to deceive yourself. The "positive spin" is about the emotional aspects of thought, not bending the truth.
You may enjoy the work of R.D. Laing.
https://en.wikipedia.org/wiki/R._D._Laing
https://en.wikipedia.org/wiki/R._D._Laing
It's sad the CBT is pushed to the forefront by regulation and funding, but there are certain conditions where we know it may not help, and beyond that may be harmful.
I know for GAD, SPD and similar illnesses where anxiety is a core component, that a combination of methods, where at least one is DBT, is one of the recommendations. However, there are fewer practitioners for it.
I know for GAD, SPD and similar illnesses where anxiety is a core component, that a combination of methods, where at least one is DBT, is one of the recommendations. However, there are fewer practitioners for it.
CBT in a nutshell: "our theory works on paper, it's your problem if it doesn't work for you"
It more it works experimentally in many cases eg:
>CBT showed higher response rates than the comparison conditions in 7 of these reviews and only one review reported that CBT had lower response rates than comparison treatments. In general, the evidence-base of CBT is very strong. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3584580/
And I guess a lot of doctors are not that up on the other therapies.
>CBT showed higher response rates than the comparison conditions in 7 of these reviews and only one review reported that CBT had lower response rates than comparison treatments. In general, the evidence-base of CBT is very strong. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3584580/
And I guess a lot of doctors are not that up on the other therapies.
What (if anything) have you found works for you?
Try EMDR?
I met an EMDR person once who I think roughly accurately describes CBT as how to deal with issues, and EMDR solves them so you don't have to deal with them in the first place.
Worth a try.
I met an EMDR person once who I think roughly accurately describes CBT as how to deal with issues, and EMDR solves them so you don't have to deal with them in the first place.
Worth a try.
I tried this, ended up with no results and down a few hundred euros.
It might work, depending on the person and the person teaching/applying it.
Not for me though.
I'm not psychotherapy's biggest fan, but I did do 2 years training in it, and I must say the world is a better place for psychotherapy's existence. Because before psychotherapy we were cutting bits of people's brains out and electrocuting them. For all Freud's frankly odd theories he was the first big name to stand up and suggest that well intentioned dialogue was enough to help traumatised people.
It's not rocket science, we don't need any big theories or research to know that talking helps. And of course by that same token some combinations of client and therapist are going to be constructive and some damaging. I believe psychotherapy is first and foremost an institution of accountability not academic theory.
It's not rocket science, we don't need any big theories or research to know that talking helps. And of course by that same token some combinations of client and therapist are going to be constructive and some damaging. I believe psychotherapy is first and foremost an institution of accountability not academic theory.
>Because before psychotherapy we were cutting bits of people's brains out and electrocuting them.
The great tragedy is that cutting bits of people's brains out and electrocuting them worked. It still does. Electroconvulsive therapy is still available and highly effective. Here in the UK, we still have two specialist psychosurgery units that perform a handful of procedures every year to treat the most severe cases of depression and obsessive-compulsive disorder.
Psychosurgery used to be crude, dangerous and often ineffective, but that's because surgery used to be crude, dangerous and often ineffective. We pretty much abandoned psychosurgery before the invention of CT and MRI, before the invention of endoscopic surgery, stereotaxy and the gamma knife. There is tremendous potential for psychosurgery that remains largely unexplored.
For all the cheerleading about how humane and enlightened we are, for all the drugs and talking therapies we have, it remains the case that many people with severe mental illnesses never find an effective treatment. We were right to stop locking people up in asylums and stop hammering icepicks through their eye sockets, but we've become incredibly blasé about the millions of people living lives of misery who we are unable or unwilling to help. Take a walk around downtown San Francisco and you'll see the legacy of deinstitutionalisation - thousands of people who are incapable of caring for themselves, just dumped on the street.
What if future generations decide that our ideology is just as barbaric as the one it replaced?
The great tragedy is that cutting bits of people's brains out and electrocuting them worked. It still does. Electroconvulsive therapy is still available and highly effective. Here in the UK, we still have two specialist psychosurgery units that perform a handful of procedures every year to treat the most severe cases of depression and obsessive-compulsive disorder.
Psychosurgery used to be crude, dangerous and often ineffective, but that's because surgery used to be crude, dangerous and often ineffective. We pretty much abandoned psychosurgery before the invention of CT and MRI, before the invention of endoscopic surgery, stereotaxy and the gamma knife. There is tremendous potential for psychosurgery that remains largely unexplored.
For all the cheerleading about how humane and enlightened we are, for all the drugs and talking therapies we have, it remains the case that many people with severe mental illnesses never find an effective treatment. We were right to stop locking people up in asylums and stop hammering icepicks through their eye sockets, but we've become incredibly blasé about the millions of people living lives of misery who we are unable or unwilling to help. Take a walk around downtown San Francisco and you'll see the legacy of deinstitutionalisation - thousands of people who are incapable of caring for themselves, just dumped on the street.
What if future generations decide that our ideology is just as barbaric as the one it replaced?
Strawman. Neurosurgery is being practiced today but the context is entirely different.
Electroconvulsive therapy is still practiced. It is done under anesthesia and better calibrated than the horror show people tend to imagine.
https://www.mayoclinic.org/tests-procedures/electroconvulsiv...
https://www.mayoclinic.org/tests-procedures/electroconvulsiv...
> we were cutting bits of people's brains out and electrocuting them
in some cases. in other cases not.
see also: monasticism, healthy spiritual/religious practices.
in some cases. in other cases not.
see also: monasticism, healthy spiritual/religious practices.
...monasticism was never healthy. I really defy someone to read the Rule of Saint Benedict and not think of a modern prison at least once. Monasticism is even considered spiritually dangerous at times, and is linked to its own specific sin, Acedia:
https://en.wikipedia.org/wiki/Acedia
I recommend Kathleen Harris's The Noonday Demon for a good account of that. If anything, monastic life would destroy you if you suffered from depression, not heal you.
https://en.wikipedia.org/wiki/Acedia
I recommend Kathleen Harris's The Noonday Demon for a good account of that. If anything, monastic life would destroy you if you suffered from depression, not heal you.
indeed. in fact i got into psychotherapy via meditation, which is actually my preferred therapeutic practice.
Therapy has really helped me, for a number of reasons:
- It helped reduce my stress level and helped me cope.
- My therapists have made constructive, useful suggestions and provided insights that I hadn't thought of on my own.
- I've faced and dealt with things I've avoided facing and dealing with on my own.
- I've come to understand myself much better.
Those things alone are worth their weight in gold for me. That said, I've completely avoided CBT and related short-term, "evidence-based" therapies. Instead, I've preferred to work with therapists who have more of a Jungian, depth psychology approach, which are a much better fit for me.
In addition to therapy, in recent years I've been eating a lot healthier, started exercising and supplementing nutrients that I was deficient in and all of these changes have had a very positive effect on my mood, health, and energy level.
I also journal a lot, and that also helps me to destress and put things in perspective. It's often almost as good as talking to someone.
Back to the subject of therapy: I believe it's absolutely critical to find a therapist that you like, respect, and can easily talk to and open up to. The other half of the equation is your own willingness and ability to put in the hard work of both confronting the difficult issues you need to in therapy and following through outside of therapy. Without all of these things coming together, the results are likely to be disappointing.
- It helped reduce my stress level and helped me cope.
- My therapists have made constructive, useful suggestions and provided insights that I hadn't thought of on my own.
- I've faced and dealt with things I've avoided facing and dealing with on my own.
- I've come to understand myself much better.
Those things alone are worth their weight in gold for me. That said, I've completely avoided CBT and related short-term, "evidence-based" therapies. Instead, I've preferred to work with therapists who have more of a Jungian, depth psychology approach, which are a much better fit for me.
In addition to therapy, in recent years I've been eating a lot healthier, started exercising and supplementing nutrients that I was deficient in and all of these changes have had a very positive effect on my mood, health, and energy level.
I also journal a lot, and that also helps me to destress and put things in perspective. It's often almost as good as talking to someone.
Back to the subject of therapy: I believe it's absolutely critical to find a therapist that you like, respect, and can easily talk to and open up to. The other half of the equation is your own willingness and ability to put in the hard work of both confronting the difficult issues you need to in therapy and following through outside of therapy. Without all of these things coming together, the results are likely to be disappointing.
I've shared similar sentiments in various threads, but yes, for some people psychotherapy has an adverse effect.
I honestly believe this happens because the person getting therapy does not respond well to hyperfocus on themselves. There's a point at which oneself must be able to say 'yes, I'm okay, I don't need help anymore' and modern psychotherapy doesn't really have anything beyond 'algorithms' to really establish that.
Once labeled ill, it feels like it can be with you forever. I'm sure some mental health care professionals believe that's an essential crutch mentally ill people need, but from personal experience it can be just as handicapping as it is intended to be helpful.
Sometimes people just want to know they'll be psychologically fine independently, and that's not something psychotherapy can prove to a person while guiding them.
It's not an easy problem, but it exists. Also, pointing out problems doesn't mean oneself created them. It's something humanity needs to work on collectively.
I honestly believe this happens because the person getting therapy does not respond well to hyperfocus on themselves. There's a point at which oneself must be able to say 'yes, I'm okay, I don't need help anymore' and modern psychotherapy doesn't really have anything beyond 'algorithms' to really establish that.
Once labeled ill, it feels like it can be with you forever. I'm sure some mental health care professionals believe that's an essential crutch mentally ill people need, but from personal experience it can be just as handicapping as it is intended to be helpful.
Sometimes people just want to know they'll be psychologically fine independently, and that's not something psychotherapy can prove to a person while guiding them.
It's not an easy problem, but it exists. Also, pointing out problems doesn't mean oneself created them. It's something humanity needs to work on collectively.
What I'd like to see is a comparison of psychotherapy to just paying a normal person with common sense but no psychological training to sit and listen and talk to people to help with their issues.
I'm convinced that the latter would be more effective most of the time, but I'd love to see it studied.
I'm convinced that the latter would be more effective most of the time, but I'd love to see it studied.
Same, I often feel that therapy is filling in a gap that really should be filled by friends and communities. Therapists at least have the training to not tell depressed people to cheer up, though.
I’m stuck in this situation at the moment. I’m seeing a therapist but my main problem is loneliness. I find I look forward to our sessions just because I get the chance to talk to someone for an hour, but I’m not sure whether I’m gaining much else from the therapy.
Ironically friends and family are usually the first to recommend therapy.
I saw a study once - at least it was mentioned in my psychology text book that the results were about the same.
I'd be very interested in seeing that study or text book.
Certain treatments have outcomes with high variance even when practiced perfectly.
Combined with no clear way to evaluate whether the treatment is being applied well, this makes it difficult for practitioners and patients to evaluate treatment quality. Which discourages expertise development in the first place (why bother working really hard when the results are hard to pin down anyway?).
Combined with no clear way to evaluate whether the treatment is being applied well, this makes it difficult for practitioners and patients to evaluate treatment quality. Which discourages expertise development in the first place (why bother working really hard when the results are hard to pin down anyway?).
> For the reader undertaking psychotherapy or who knows someone who is, it is worth keeping some perspective: this is just one critique and the weight of evidence still suggests that psychotherapy is, more often than not, beneficial.
It's good to bring a more critical eye to the field - but be mindful that it's still overall beneficial. My own experience has lead me to find it helpful, but not able to really address the core of issues. And maybe that's too much to ask for - but it's certainly not something they object to trying to address.
It's good to bring a more critical eye to the field - but be mindful that it's still overall beneficial. My own experience has lead me to find it helpful, but not able to really address the core of issues. And maybe that's too much to ask for - but it's certainly not something they object to trying to address.
[deleted]
> Evangelou and his team conclude that the field of psychotherapy research needs to work harder to ensure that negative results are published as well as good news results, especially given the findings of another recent paper suggesting that the field has a problem with undeclared researcher allegiance to particular therapeutic approaches.
And from that other recent paper:
> Reviews with a conclusion in favour of psychological therapies (vs pharmacological interventions) were at high risk for a spin in conclusions
For a field so rich in therapeutic models, I find it somewhat surprising that people are not more educated, walking in to visit with a therapist, as to what kind of model or therapy is being used, and what alternatives might be available.
I'm not a psychologist myself but rather a coach, and I love taking little breaks with my clients to move to a meta-perspective and walk them through the variety of models we can use together. Eventually they learn that each model has key leverage points as well as key weaknesses, and tying oneself to a single model as if it has no significant blind spots can quickly put one's desired outcomes at risk.
Maybe some psychologists here can weigh in; perhaps this is already a thing in the therapy world.
And from that other recent paper:
> Reviews with a conclusion in favour of psychological therapies (vs pharmacological interventions) were at high risk for a spin in conclusions
For a field so rich in therapeutic models, I find it somewhat surprising that people are not more educated, walking in to visit with a therapist, as to what kind of model or therapy is being used, and what alternatives might be available.
I'm not a psychologist myself but rather a coach, and I love taking little breaks with my clients to move to a meta-perspective and walk them through the variety of models we can use together. Eventually they learn that each model has key leverage points as well as key weaknesses, and tying oneself to a single model as if it has no significant blind spots can quickly put one's desired outcomes at risk.
Maybe some psychologists here can weigh in; perhaps this is already a thing in the therapy world.
> For a field so rich in therapeutic models, I find it somewhat surprising that people are not more educated, walking in to visit with a therapist, as to what kind of model or therapy is being used, and what alternatives might be available.
This seems like a bizarre expectation to me. People walking in about a stomach problem generally don't know much about that subject, either. I'm not sure what the ratio is, but unless you only see people from a very narrow background, I don't really see why the average person would be educated in psychological techniques any more than they're educated in types of rock.
This seems like a bizarre expectation to me. People walking in about a stomach problem generally don't know much about that subject, either. I'm not sure what the ratio is, but unless you only see people from a very narrow background, I don't really see why the average person would be educated in psychological techniques any more than they're educated in types of rock.
When I worked in the health system, specifically around pain relief, there was a comparison of different approaches. Among them was "distraction therapy." That phrase has stuck with me, and I think it applies to many therapies people are mentioning here. It's basically a variation of "hit your head so you don't notice your sore elbow." But with the right application I think it can be entirely positive. If the attention required of therapy X shifts you away from problem Y, even if it's not really "helpful" on its own, then it's an excellent therapy. This is why some people realize they'd rather get a gym membership than therapy sessions. That said, I think psychotherapy, as an intentional focus on underlying or neurochemical issues, can go much deeper than this approach and should be considered by many people (though positive results could themselves be considered a 'distraction' if they don't address an inherent problems).
I happen to have some knowledge and experience with something called "Neuro-Linguistic Programming". It's a rigorous but unscientific body of ideas and techniques that roughly amounts to an "operating system" for the human mind.
(From the POV of a computer programmer it is interesting to note that the origin of NLP involved the analysis of videos of therapy sessions of a few highly effective therapists[1], done with the aid of Chomsky's Transformational Grammar, which of course is related to the Chomsky hierarchy of grammars...)
I've always been disappointed that whenever people "do science to" NLP it seems to fall flat. I have to assume the studies are flawed somehow because I personally know damn well the techniques work. Yet the wikipedia entry is all about how it's a pseudoscience. It's a very frustrating situation.
[1] Virginia Satir, Fritz Perls, and Milton Erickson, I believe were the main ones.
(From the POV of a computer programmer it is interesting to note that the origin of NLP involved the analysis of videos of therapy sessions of a few highly effective therapists[1], done with the aid of Chomsky's Transformational Grammar, which of course is related to the Chomsky hierarchy of grammars...)
I've always been disappointed that whenever people "do science to" NLP it seems to fall flat. I have to assume the studies are flawed somehow because I personally know damn well the techniques work. Yet the wikipedia entry is all about how it's a pseudoscience. It's a very frustrating situation.
[1] Virginia Satir, Fritz Perls, and Milton Erickson, I believe were the main ones.
I have a similar experience with a mix of therapies I've undertaken over the past few years.
The main ones I've used are NET, kinesiology, EFT/tapping and holotropic breathwork, and a bit of Erickson hypnotherapy.
I've been aware of NLP and dabbled in it a little about 10 years ago, but ended up finding the abovementioned approaches more effective for my issues.
But they seem to work at the same level; like NLP, NET and kinesiology focus on finding incongruence in the body and mind, and undertaking a learning/healing process to enable transitioning to a state of congruence.
After 6-7 years of this work, I've almost completely overcome chronic fatigue, anxiety (social & general) and depression, as well as several other symptoms I can now recognise in retrospect (possibly a combination of borderline/histrionic/narcissistic PD symptoms).
There is some research indicating the effectiveness of NET [1], but it will have a hard time gaining mainstream acceptance given its origins/professional associations and the specifics of the treatment.
It's also super-hard to do a full-scale trial for these kinds of treatments, as it's very difficult to assemble cohorts of subjects with similar enough symptoms, and the it takes years for really profound changes to happen. So it's hard to imagine who would have the funds and the timeframes required to undertake the kind of study that would be necessary to properly test this stuff - not to mention who would have the incentive, given that there's no drug patent pot of gold at the end.
Yet year by year I keep doing these practices and my life keeps getting better, while I watch on as other people I know keep persisting with conventional psychology and psychiatry, without a whole lot of success beyond the superficial.
I've come to understand enough about what keeps the status quo in place to no longer be frustrated by it. My approach now is to share my experiences with whomever is interested, and trust that those who need/want to know about will take notice give it a try when they're ready.
Enough people have given these techniques a shot and gotten great results that I'm optimistic that more widespread acceptance can happen eventually, somehow.
[1] http://www.onefoundation.org/current-research-updated/
The main ones I've used are NET, kinesiology, EFT/tapping and holotropic breathwork, and a bit of Erickson hypnotherapy.
I've been aware of NLP and dabbled in it a little about 10 years ago, but ended up finding the abovementioned approaches more effective for my issues.
But they seem to work at the same level; like NLP, NET and kinesiology focus on finding incongruence in the body and mind, and undertaking a learning/healing process to enable transitioning to a state of congruence.
After 6-7 years of this work, I've almost completely overcome chronic fatigue, anxiety (social & general) and depression, as well as several other symptoms I can now recognise in retrospect (possibly a combination of borderline/histrionic/narcissistic PD symptoms).
There is some research indicating the effectiveness of NET [1], but it will have a hard time gaining mainstream acceptance given its origins/professional associations and the specifics of the treatment.
It's also super-hard to do a full-scale trial for these kinds of treatments, as it's very difficult to assemble cohorts of subjects with similar enough symptoms, and the it takes years for really profound changes to happen. So it's hard to imagine who would have the funds and the timeframes required to undertake the kind of study that would be necessary to properly test this stuff - not to mention who would have the incentive, given that there's no drug patent pot of gold at the end.
Yet year by year I keep doing these practices and my life keeps getting better, while I watch on as other people I know keep persisting with conventional psychology and psychiatry, without a whole lot of success beyond the superficial.
I've come to understand enough about what keeps the status quo in place to no longer be frustrated by it. My approach now is to share my experiences with whomever is interested, and trust that those who need/want to know about will take notice give it a try when they're ready.
Enough people have given these techniques a shot and gotten great results that I'm optimistic that more widespread acceptance can happen eventually, somehow.
[1] http://www.onefoundation.org/current-research-updated/
This sounds really interesting, and a comment like yours is exactly why I came to this thread.
Yet year by year I keep doing these practices and my life keeps getting better [...]
I've learned to tread cautiously with this stuff as it's a topic that triggers hostility in some, though plenty of others like yourself are looking for this info, so I'm happy to risk the backlash if it might help someone.
I should emphasise that anyone experiencing mental illness should consult a mainstream psychiatrist first, in case they need medication or other professional care. The techniques below are for people who have a solid baseline of mental health, but want to find better success and happiness in their career, relationships, etc.
For NET, search for "NetMindBody" and find a local practitioner. They're all over the world. Alternately, look for Psych-K or BodyTalk System - they're variants of the same concept. Ultimately you'll want to learn how to do it yourself rather than paying a practitioner, so you can search Meetup.com for "muscle testing" and you might find a local group and meet some like-minded folk on the same journey.
For "holotropic breathwork", a Google search will point you to solid info and local instructors. FYI it was conceived by Stanislav Grof, a psychiatrist who pioneered research into LSD before it was outlawed.
EFT/tapping is all over YouTube. Its biggest proponents push it as a be-all-and-end-all, but for me it's only been a small component of the overall approach, though still an important one at times.
Practitioners of Erickson hypnosis are everywhere, so it should be easy to find someone local. This one has also been minor for me but still valuable.
A well-known book offering some science behind the mind/body congruence concept is Bruce Lipton's 2006 book the Biology of Belief [1].
Lipton is a credentialed scientist himself (PhD cell biology researcher at Stanford School of Medicine), but he gets hand-wavy about concepts like epigenetics and quantum entanglement and leaves himself vulnerable to attack from mainstream skeptics.
But it's only by applying the principles he describes that I've been able to make the progress I've made over the past 6-7 years.
For more info, you're welcome to contact me directly - email in bio.
[1] https://www.amazon.com/Biology-Belief-10th-Anniversary-Consc...
I should emphasise that anyone experiencing mental illness should consult a mainstream psychiatrist first, in case they need medication or other professional care. The techniques below are for people who have a solid baseline of mental health, but want to find better success and happiness in their career, relationships, etc.
For NET, search for "NetMindBody" and find a local practitioner. They're all over the world. Alternately, look for Psych-K or BodyTalk System - they're variants of the same concept. Ultimately you'll want to learn how to do it yourself rather than paying a practitioner, so you can search Meetup.com for "muscle testing" and you might find a local group and meet some like-minded folk on the same journey.
For "holotropic breathwork", a Google search will point you to solid info and local instructors. FYI it was conceived by Stanislav Grof, a psychiatrist who pioneered research into LSD before it was outlawed.
EFT/tapping is all over YouTube. Its biggest proponents push it as a be-all-and-end-all, but for me it's only been a small component of the overall approach, though still an important one at times.
Practitioners of Erickson hypnosis are everywhere, so it should be easy to find someone local. This one has also been minor for me but still valuable.
A well-known book offering some science behind the mind/body congruence concept is Bruce Lipton's 2006 book the Biology of Belief [1].
Lipton is a credentialed scientist himself (PhD cell biology researcher at Stanford School of Medicine), but he gets hand-wavy about concepts like epigenetics and quantum entanglement and leaves himself vulnerable to attack from mainstream skeptics.
But it's only by applying the principles he describes that I've been able to make the progress I've made over the past 6-7 years.
For more info, you're welcome to contact me directly - email in bio.
[1] https://www.amazon.com/Biology-Belief-10th-Anniversary-Consc...
See also Buddhism.
I participated in 3 CBT sessions 10 years ago I asked what will I get out of 6 sessions (the most my employer would pay for). The therapist said I would know my problems but not solved any of them. I did not attend any further sessions. I am a male programmer with bipolar. I did try a excel based survey labelled CBT which quantified where I was on general personality traits which was OK and free. I did read some popular therapy books. I could probably do with more work focussed excutive coach lite training if I could avoid the bad ones. I called works employee helpline recently, after a manic episode, I will see how that goes, it is more of a seen to be doing something rather than letting mania (occasionally) take its natural course.
This article could be summarized in two sentences, both of which should be unsurprising to most HN readers:
1. Publication bias means that the reported results for efficacy of psychotherapy are likely to be stronger than the actual efficacy. 2. Observational studies showed a negative relationship between mental health outcomes and psychotherapy.
The clickbait title aside, 1 is not really news as this bias affects every field, especially social science, and has been widely reported. 2 is basically a no-op. You cannot under a causal relationship based only on observational studies. Full stop. The idea that people who developed poor mental health sought professional help is if anything more plausible than the clickbaity alternative.
1. Publication bias means that the reported results for efficacy of psychotherapy are likely to be stronger than the actual efficacy. 2. Observational studies showed a negative relationship between mental health outcomes and psychotherapy.
The clickbait title aside, 1 is not really news as this bias affects every field, especially social science, and has been widely reported. 2 is basically a no-op. You cannot under a causal relationship based only on observational studies. Full stop. The idea that people who developed poor mental health sought professional help is if anything more plausible than the clickbaity alternative.
From the article:
> For the reader undertaking psychotherapy or who knows someone who is, it is worth keeping some perspective: this is just one critique and the weight of evidence still suggests that psychotherapy is, more often than not, beneficial.
> For the reader undertaking psychotherapy or who knows someone who is, it is worth keeping some perspective: this is just one critique and the weight of evidence still suggests that psychotherapy is, more often than not, beneficial.
Does anyone have dependable reference for that?
I’ve had terrible martial arts instructors, inept teachers, ineffective professors, one brutal physiotherapist.
I presume that there are a fair share of bad psychotherapists as well.
That some people do not see improvement should not be surprising.
I presume that there are a fair share of bad psychotherapists as well.
That some people do not see improvement should not be surprising.
I don't think anyone would suggest that there should be perfectly consistent outcomes, rather, on the whole that outcomes should be positive. We know there will be poor performers.
The study is suggesting that 'on the whole', there are negative outcomes, implying that 'most psychotherapists' are just bad at what they do, or more likely, there's a more fundamental issue with the nature of psychotherapy itself.
The study is suggesting that 'on the whole', there are negative outcomes, implying that 'most psychotherapists' are just bad at what they do, or more likely, there's a more fundamental issue with the nature of psychotherapy itself.
All these things have something in common.
Martial arts is definitely an area where I don't give it much stock because a lot of it seems rather iffy. If that's where therapy is, it'd be good to know.
Martial arts is definitely an area where I don't give it much stock because a lot of it seems rather iffy. If that's where therapy is, it'd be good to know.
Proponents of more "evidence based" psychotherapies usually oversell their "scientific" rigour (even if there are several question on their reproducibility) while usually leaving the patient's own characteristics in the background plane (or just ignoring it).
Realizing what you are feeling/thinking and being able to say that is halfway to the solution.
And yes, it is very dependant on practitioner and on the patient's own willingness. (In the same way exercise is good but if you run 100m per day or lift light weights at the gym it won't do much)
Realizing what you are feeling/thinking and being able to say that is halfway to the solution.
And yes, it is very dependant on practitioner and on the patient's own willingness. (In the same way exercise is good but if you run 100m per day or lift light weights at the gym it won't do much)
The untold truth is that therapy is not for all people. Similarly, meditation is not for all people either. For some people, neither therapy nor meditation really work. For those people, medication to elevate mood is the only real option. I have seen too many therapists exploit this and raise hopes of their patients and try CBT for a long time without results. Just like any disease, you need to manage this and there is nothing wrong in taking medication to fix yourself.
My viewpoint on mental health: how you feel at any given moment and how long that feeling will persist will depend on the structure of your brain and the environment in which your brain is in. There are a huge number of variables at play. This environment includes things like: baseline levels of chemical signalling of various kinds going on in your brain (this is plainly apparent when you do any sort of perception or mood altering substance which significantly changes the chemical signalling in your brain); physical health of the body attached to the brain; inputs from your senses and any feelings that may be arising as a result of these inputs; beliefs and assumptions about the world in which you're in; and finally structural considerations of your brain (e.g. is some part of your brain damaged or non-existent). For some people, the majority of problems lie in the "beliefs and assumptions about the world" variable and for these people, therapy is the answer. I imagine for the large majority of people, therapy may give some minor benefits but if you don't attend to your own physical and emotional needs on a regular basis, you are going to feel like garbage. This means eating a healthy diet (with enough calories), getting some exercise, spending time with family and friends, taking some time for yourself to relax and unwind. For those with persistent chemical signalling or structural problems in their brains, they may have to do way more to feel right, including getting on the right drugs and therapy for emotional support. It may suck, but we can only play the hand we're dealt.
A few more thoughts on this topic: the world we live in now is so different from the one humans evolved in. We eat different food and eat way more frequently than our ancestors did. We exercise way less and spend very long periods of time in low to medium stress situations instead of short periods of time in high stress situations, which is what our stress response system evolved for. Many of us live semi-isolated lives thinking about how we can help ourselves as individuals instead of living in small to medium sized groups thinking about how we can help ourselves within the context of the group (you would likely have to be doing prosocial things with higher regularity). While there are many advantages of living in the world we now live in as compared to how our paleolithic ancestors lived, there are some incompatibilities with how we have evolved and I think we should be doing more as a society to address these issues.
A few more thoughts on this topic: the world we live in now is so different from the one humans evolved in. We eat different food and eat way more frequently than our ancestors did. We exercise way less and spend very long periods of time in low to medium stress situations instead of short periods of time in high stress situations, which is what our stress response system evolved for. Many of us live semi-isolated lives thinking about how we can help ourselves as individuals instead of living in small to medium sized groups thinking about how we can help ourselves within the context of the group (you would likely have to be doing prosocial things with higher regularity). While there are many advantages of living in the world we now live in as compared to how our paleolithic ancestors lived, there are some incompatibilities with how we have evolved and I think we should be doing more as a society to address these issues.
The big problem with therapy is that it is too expensive to be available to most people. We need to find some viable alternative that doesn't depend on paying a very costly human to listen for an hour a week.
there are also a lot of quacks around. doesn't help that psychotheraphy really lacks a solid background in medicine tbh. we're only scratching the surface of the deep mind structures and issues stemming from there and how they all relate to trauma or even what trauma actually is and yet pretend like we can cure ailments talking people out of it.
You need some people in your life you click with.
A big issue I see is this idea of judging outcomes as positive/negative, instead of accepting people's processes.
After starting therapy, I cut off communication from my parents at least twice. Is this a positive example of someone who's codependently avoiding their parents or someone learning to detach from their parents?
Trick question: it's both.
Another issue with measuring effectiveness is we aren't gathering information about the therapists' beliefs/mindsets. I dropped a therapist because she started adopting my own parents' financial insecurities, shouted "you're going to run out of money" at me a couple times during a session. Anxiety over money was a key issue for me, so I asked her multiple times not to repeat messages to me that might reinforce my thinking. She ended the session with a comment about running out of money, so I dropped her.
I've since gotten over my money anxieties to the point that I've essentially taken a vow of service & poverty as I try to minimize my participation in capitalism. While I'm happy and love my new life free from worrying about money or how to meet my needs, I don't know if this would be considered a desirable therapeutic outcome when considering the rest of society. Of course, society's wellbeing is also really subjective and we are slow to evaluate our culture for long-term effects.
I also started practicing Nonviolent Communication 2.5 years ago. For a while, I was kind of robotic in my communication style after, since I was structuring most sentences as "When (I|you) <observation without evaluation>, (I|you) feel <emotions without evaluation>, because (I|you) need <specific human need without specifying strategy for meeting the need>." Is this temporary rigidity considered negative? What about any person who sticks with the language they use throughout their life?
We program ourselves & each other with our words and I view therapy sessions as guided debugging sessions where I work to figure out ways I've programmed myself or been programmed that are unsustainable. This perspective is therapeutically useful to me & the success of my therapy sessions has deepened, as a result. These days, therapy is more of a safe guard to keep me in check as I play with my mind and perceptions, though I'm still working on my anxiety with writing. I don't know how any of that can be accounted for in these studies and while I may be an outlier, I know that learning to pay attention to outliers is how innovations can come about.
After starting therapy, I cut off communication from my parents at least twice. Is this a positive example of someone who's codependently avoiding their parents or someone learning to detach from their parents?
Trick question: it's both.
Another issue with measuring effectiveness is we aren't gathering information about the therapists' beliefs/mindsets. I dropped a therapist because she started adopting my own parents' financial insecurities, shouted "you're going to run out of money" at me a couple times during a session. Anxiety over money was a key issue for me, so I asked her multiple times not to repeat messages to me that might reinforce my thinking. She ended the session with a comment about running out of money, so I dropped her.
I've since gotten over my money anxieties to the point that I've essentially taken a vow of service & poverty as I try to minimize my participation in capitalism. While I'm happy and love my new life free from worrying about money or how to meet my needs, I don't know if this would be considered a desirable therapeutic outcome when considering the rest of society. Of course, society's wellbeing is also really subjective and we are slow to evaluate our culture for long-term effects.
I also started practicing Nonviolent Communication 2.5 years ago. For a while, I was kind of robotic in my communication style after, since I was structuring most sentences as "When (I|you) <observation without evaluation>, (I|you) feel <emotions without evaluation>, because (I|you) need <specific human need without specifying strategy for meeting the need>." Is this temporary rigidity considered negative? What about any person who sticks with the language they use throughout their life?
We program ourselves & each other with our words and I view therapy sessions as guided debugging sessions where I work to figure out ways I've programmed myself or been programmed that are unsustainable. This perspective is therapeutically useful to me & the success of my therapy sessions has deepened, as a result. These days, therapy is more of a safe guard to keep me in check as I play with my mind and perceptions, though I'm still working on my anxiety with writing. I don't know how any of that can be accounted for in these studies and while I may be an outlier, I know that learning to pay attention to outliers is how innovations can come about.
My suspicion is that many people going to therapy are lacking in one or more items from the basic hierarchy of needs.
I went to therapy once. In hindsight I'd have been better off with a girlfriend and friend companionship.
I'd ask myself.
1. Am I getting good quality sleep? 2. Am I getting good quality food? 3. Am I interacting with people socially? 4. Am I sexually active? 5. Am I physically active to the point of breaking sweat?
The mental and physical are intertwined and it is easy to forget to take care of yourself. Your machine requires maintenance.
I don't only mean sometimes take it easy - that too - but also people can grow very neurotic by ignoring their social and sexual needs, and like a machine - we are meant to perform functions - without which we can suffer aka a certain amount of physical or mental stress is good for us and we can err by doing too little or too much.
I went to therapy once. In hindsight I'd have been better off with a girlfriend and friend companionship.
I'd ask myself.
1. Am I getting good quality sleep? 2. Am I getting good quality food? 3. Am I interacting with people socially? 4. Am I sexually active? 5. Am I physically active to the point of breaking sweat?
The mental and physical are intertwined and it is easy to forget to take care of yourself. Your machine requires maintenance.
I don't only mean sometimes take it easy - that too - but also people can grow very neurotic by ignoring their social and sexual needs, and like a machine - we are meant to perform functions - without which we can suffer aka a certain amount of physical or mental stress is good for us and we can err by doing too little or too much.
For a lot of people, deeply subjective-analytical thinking of this sort is very brittle, and they lack the experience that would teach them what to do even if they knew they were lacking some important thing on the hierarchy.
It also happens that some very depressed and anxious people will e.g. read only the "criticisms" portion of the Wikipedia page for the hierarchy concept, and determine in the end that what they need is an experienced professional rather than a possibly-unscientific concept. This is really sad to observe, because their inability to be open to certain kinds of information can make them more dependent, not less.
It also happens that some very depressed and anxious people will e.g. read only the "criticisms" portion of the Wikipedia page for the hierarchy concept, and determine in the end that what they need is an experienced professional rather than a possibly-unscientific concept. This is really sad to observe, because their inability to be open to certain kinds of information can make them more dependent, not less.
It is easy to dismiss 'get laid' as boorish and interpret 'did you get enough sleep?' or get out more' as semi-accusatory, because we're prone to thinking crude feedback is less apt for us, we must be more complex than this.
Look at the rise of ASMR videos. Millions of people desire an experience,a simulation, of being touched in a non-sexual way. This isn't a critique of ASMR - it's fine - but there's this simple need at the heart of it - little different to those gorillas grooming each other.
There's a running gag in AMSR circles where the ASMR viewer is interrupted by somebody and reacts by <laptop lid slam> pretending they were watching porn.
Hackerspaces and makerspaces are a great thing. I heard a quote recently "Women communicate, men shoulder to shoulder".
Look at the rise of ASMR videos. Millions of people desire an experience,a simulation, of being touched in a non-sexual way. This isn't a critique of ASMR - it's fine - but there's this simple need at the heart of it - little different to those gorillas grooming each other.
There's a running gag in AMSR circles where the ASMR viewer is interrupted by somebody and reacts by <laptop lid slam> pretending they were watching porn.
Hackerspaces and makerspaces are a great thing. I heard a quote recently "Women communicate, men shoulder to shoulder".
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The only psychotherapy we need is from plant medicines. DMT and psilocybin are natural plant teachers that can help us through the traumas we go through in our life.
I'd add MDMA in there as well. It's had good results in testing for PTSD (look up MAPS) and it changed my life for sure. Not a plant, but I hold onto no idealism about that.
It was commonly synthesized from sassafras oil (safrole) so you can add it to the list I think:
https://erowid.org/archive/rhodium/chemistry/safrolefaq.html
https://erowid.org/archive/rhodium/chemistry/safrolefaq.html
I agree with you. LSD trips gave my life new meaning.
Add cocain and weed to that list as well
Wow very intelligent. Your comment really made me think.
Please don't respond to a bad comment with a worse one, and certainly not by getting personally nasty.
https://news.ycombinator.com/newsguidelines.html
https://news.ycombinator.com/newsguidelines.html
A. No standards of treatment. It is therapists choice, and therapists are free to pick and choose whatever they want. Because results are so hard to measure, therapists who are really bad at their job can continue to operate, dragging overall results for the field down.
B. Licensing requirements are all over the place. From psychologists with PhDs from well established institutions, to people who got an online professional degree. The type of training someone receives heavily impacts their approach to therapy, and the quality of their education determines how high quality their treatment program can be.
For fun sometime, pay the arm and a leg it costs to get a full battery of psychology tests done from a psychologist. You'll get a personality test and an actual IQ score. It takes a long time (multiple sessions each lasting a couple hours), but you will get to see the real scientific part of psychology.
I actually got a practical result out of it. My doctor was able to tell me that the reason I kept dropping cups was due to a co-morbid congenital condition. Apparently a certain % of people who have an underdeveloped optic nerve also have weak grip strength.
The grip strength trainer I bought has more than paid for itself in saved cups and glasses.