Have we overestimated the effectiveness of psychotherapy?
digest.bps.org.uk
digest.bps.org.uk
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.
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/$.
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 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 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
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.
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.
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.
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.
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.
A real intervention doesn’t require someone to help themselves; an appendectomy doesn’t require patient participation and motivation.
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.
"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.
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.
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.
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.
> 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).
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 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.
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.
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".
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.
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.
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.
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'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.
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.
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.
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"?
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.
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.
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.
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 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 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 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 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.
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.
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.
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.
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.
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.
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
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.
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.
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.
> what would you be doing instead if you didn't work?
Whatever I feel like doing at the time.
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.
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.
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?
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.
Basically, psychology is just modern day quackery.
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.
in some cases. in other cases not.
see also: monasticism, healthy spiritual/religious practices.
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://www.mayoclinic.org/tests-procedures/electroconvulsiv...
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?
- 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 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'm convinced that the latter would be more effective most of the time, but I'd love to see it studied.
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?).
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.
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.
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.
(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.
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.
Yet year by year I keep doing these practices and my life keeps getting better [...]
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...
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.
> 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.
I presume that there are a fair share of bad psychotherapists as well.
That some people do not see improvement should not be surprising.
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.
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.
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)
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.
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.
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.
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.
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".
In the end, its some sort of synthetic friendship, which in a ultra-individualistic society has become rare. But its not resulting in good advice like true friendship. Its resulting in pushing egomaniac tendencies onwards.
Imagine a psychotheraphist not giving libertarian advice. "You should integrate more into your family, visit your brother more often, sacrifice a part of your life to the commons, so that the commons is more willing to sacrifice parts of its life to you.."
"I had a very bad vibe with that psychotherapist, i came to be unrepressed and he pushed for even more repression. In fact i think, i need therapy to overcome this therapy..."
https://erowid.org/archive/rhodium/chemistry/safrolefaq.html