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Comment by ggambetta | Hacker News Reader

Seeing a therapist might be infinitely better than reading a book, and not just for narcissism. We're all broken in our own wonderful and unique ways.

I've been seeing a therapist for 5 years now, and the positive impact this has had in my life and on my general self-awareness can't be overstated.

As engineers and tech people we have one tool that has proven incredible useful in our careers: our brilliant rational minds. So we tend to think that we can solve any problem in life with this tool. Turns out we can't; thinking that therapy is somehow beneath us is pure hubris.

I also resisted therapy for a long time as a matter of principle. In high school I learned about the id, ego and super-ego, and in my 17 year old wisdom I thought "This is all bullshit! Did the guy open someone's head and see three parts? No! This is all made up!" Being unquestionable older and hopefully wiser now, I've understood that "all models are wrong, but some are useful"[0]. And therapy happens to have some useful models to offer.

[0] https://en.wikipedia.org/wiki/All_models_are_wrong

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> As engineers and tech people we have one tool that has proven incredible useful in our careers: our brilliant rational minds. So we tend to think that we can solve any problem in life with this tool. thinking that therapy is somehow beneath us is pure hubris.

To add to this: we also tend to think we can correctly assess any problem without external help, but especially when it comes to the "self" this fails. It's kind of inevitable: being able to analyze a problem requires some distance, but taking distance from yourself, especially your problem areas, fundamentally goes against that. The result is blind spots.

That had been my excuse for ignoring my own problems for years so I’d add:

If you think you’re insane but also thinking it could be self-mis-diagnosis, no, you are not sane.

There is no such inherent contradiction in an ability for a logical system to detect its own anomaly were you one.

If it had been a false positive, the fact that a false positive is occurring itself is an anomaly, and an issue.

Can you elaborate on this? This reads okay but it's at a higher level of abstraction and I don't know the specific phenomena to which it's referring.

How do you distinguish these thoughts from the intrusive ones?

You go look for external help with figuring that out. Which brings us back to...

This is for me, so far, HN comment of year.

100% agree about seeing a therapist. I also resisted for years because I thought it was a waste of time and money. Now that I see one once a week I've come to realize how useful it can be to have a person you can go to who is paid to be laser focused on your mental well being for an hour at a time. One thing mine has encouraged me to do is journal. It helps air out the negative thought patterns that infect my behavior and also serves as a good way to synthesize ideas. I set aside 10-15 minutes at lunch to write in a moleskine notebook.

My problems are more related to anxiety and depression, but the same concepts apply. I also think that you get out of therapy what you put in. It sounds like you are in a good frame of mind because you want to improve yourself. That's probably the best attitude you could take going into therapy.

People say this a lot, but it never seems very actionable.

How do you do find someone good that you trust? How do you find someone worth the time? The couple of times I've tried to find someone you end up making a lot of unreturned phone calls.

Maybe I have an unfairly negative impression of therapists - I both think that it's incredibly valuable to introspect and have someone smart and thoughtful to work things out with, but also suspect a lot of therapists are neither of those things?

CBT and growth mindset seems helpful, what's the process to actually find someone successfully? How many people actually are doing therapy vs. just recommending other people do it? It seems a lot more people are recommending it than actually doing it themselves (which would explain the vague advice).

> How do you do find someone good that you trust? How do you find someone worth the time?

In my experience the best way to find someone is through recommendations. Find someone with a good therapist, and contact the therapist for recommendations. They usually know other people in the field that work with a similar approach.

I feel CBT only works with simple issues. For trauma and deep running issues I would suggest finding someone who looks into the root of issues and doesn't just try to change behaviours. See psychotherapy for example.

Otherwise it depends on where you live as well.

In Australia, and definitely for NSW:

- look for a psychiatrist instead of a psychologist. With a psychologist you get 10 sessions for free by the government, but then you have to pay the full fee yourself. This ends up being around $150-$250 per session from what I have seen. With a psychiatrist the medicare safety net kicks in, and after $2000 of out of pocket expenses you get 85% of the session fees back. In my case I end up paying ~$40 for my $350 therapy sessions which makes a huge difference when therapy can be going for years.

Happy to help out with recommendations in the NSW Australia area.

I'm in the bay area - this seems like the best option.

The difficulty is either I don't know anyone my age that has one or it's still taboo for men to talk about so people don't. I'd guess it's a combination of both. The only people I've known personally who see a therapist are women (and from that small sample they don't want you to see their same person).

I think men tend to rely entirely on their SO which is probably not a great thing for either party.

> The only people I've known personally who see a therapist are women (and from that small sample they don't want you to see their same person).

Which is fair enough. That's why I'm suggesting to not get their therapist's details to see the same person, but to get a recommendation from the therapist. Hopefully that would alleviate their concerns.

AFAIK a good therapist will not see people who are too close to each other anyway as there can be a bias on the therapist's side due to the close relationship. For example doing both couple and individual therapy with the same therapist is not a good idea.

It's already hard mustering up the courage and desire to go to therapy. Then I spend hours filling out forms, making cold-calls, completely blind -- reading Yelp reviews on therapists, man. Then I don't get callbacks and am told doctors aren't taking new patients. OK.

But everyone is happy recommending therapy. Oooh, it's sooo great! Yeah. Only if I could find some.

I'm assuming therapists designed their funnel this way, somehow, there's something about me that puts me in this category of people that can't get over the initial barrier of finding them.

This largely matches my experience too - I can’t really imagine how anyone actually having a tough time could make it through the necessary hoops to get help.

This 100%.

I feel the stupidly stressful process of trying to find a therapist itself has increased my need for therapy.

Unrelated question : do you Habs this out of pocket system applied to all medical fields? Do you need to co-pay for, say, a general practitioner?

I am asking because here in France it is either a medical field (reimbursed, an example would be a psychiatrist) or not (a psychologist for instance)

It's challenging to give specific advice on this while respecting privacy. On a site like Reddit with PM you might be able to discern that someone has an issue, is located close to you, you know a therapist, and then create a throwaway account to PM them.

These challenges are deeply personal, so finding the right person is challenging. There are lot of therapists with different qualifications and experience. People seem to study psychology, do whatever qualifications they need, and start as a therapist, but the experience part is a challenge.

I don't think this challenge is much different from finding mentors. In fact, it's probably better because it's a discrete financial transaction and the conversations are protected. Finding mentors during your career, if you don't have them directly in your workplace, can be really problematic. You have few protections, and little ability to build up trust, until you've invested time building up trust.

When it comes to men (probably the majority) on HN there are also a number of specific issues which affect take up of therapy. That's after the cost issues which affect everyone. If someone is in some countries they may have little, or no availability of certain kinds of therapy.

> How do you do find someone good that you trust? How do you find someone worth the time? The couple of times I've tried to find someone you end up making a lot of unreturned phone calls.

But it's the same with Doctors. Some doctors won't listen to your symptoms, some doctors might have old information, or brush you off.

Would you put off going to a doctor because of those problems?

It's not really the same with doctors.

With doctors there are places everyone goes where you can sign up and get a doctor which is relatively easy to schedule. From there for routine stuff there's less variability, you just do your routine checkup, and you'll be referred to experts if necessary.

There's also a higher minimum standard to get an MD.

It's both way easier to find one and easier to determine they're qualified/actually know what they're talking about (though obviously there's still variance in quality just not as bad).

With therapists there's no clarity around any of this really.

> There's also a higher minimum standard to get an MD.

If you see a psychotherapist, they have to be certified as an MD and then they get therapist training.

No. Psychologists can be psychotherapists. Psychiatrists can be psychotherapists too, but most aren't.

Ahh, sorry yes you're right. 'Psychiatrist' was what I was after.

I've had a fair number of terrible therapists and a couple of good ones. The only real solution that I can think of is to try several. Generally, you know early on. To me, it's a worthwhile endeavor.

"Find a therapist" is not vague or unactionable advice, any more than "find a doctor" or "find a mechanic" is vague or unactionable.

Find a mechanic.... for your mind

I'm actually attending therapy, on a regular schedule, and struggled to find a good therapist.

Shop around? You're inviting someone to perform online brain surgery on you. Fortunately, you can undo the operation if you don't like it (sort of). If you don't like what the therapist is doing, keep looking for a different therapist that works for you.

I've heard a story where a therapist got upset with their client because the client said, during a therapy session, they were going to find someone else.

Simple point of order: I don't need to tell my therapist if they're fired. I just walk away.

> I've heard a story where a therapist got upset with their client because the client said, during a therapy session, they were going to find someone else.

That would be a clear sign of a bad therapist. There very much has to be room to discuss seeing someone else, and whether the therapy relationship is working.

Yes, obviously, that was my point.

But an additional point is worth making, the kind of thing that a good therapist would help you see.

> I don't need to tell my therapist if they're fired. I just walk away.

I am stating that as clearly as I can there. If my therapist starts acting in a way that makes me uncomfortable, no more talk. No need to talk. I don't need my therapist's permission to walk away.

I just. walk. away.

> I just. walk. away.

Though you might want to get in contact with your insurance if they are paying for it, since having it on your record as aborted for no reason could cause issues when convincing them to pay the next one.

I go by recommendations, but I'm initially looking for chemistry - does this person jump to conclusions based on initial statements, is there an urgency in their tone (as in, getting to it rather than getting to know you), and most importantly, being able to verbalize their process and walk you through their methods. It shouldn't be smoke & mirrors or duplicitous, like asking you open ended questions and letting you blow off steam for 45 minutes, it should be a 'conversation' with them drawing you back to the central issues you identified & they've diagnosed.

Like all relationships, it's predicated on trust, and that means finding the right professional. There are shops that make their retirement letting people talk about themselves for an hour once a week, and there are others genuinely engaged in the art of helping people heal themselves.

So true! I do a dbt skills group and as a RULE i am the only make, ever. Men just don't do therapy well.

Honest question, really trying hard not to word it in a standoffish way: what do you get out of a therapist that can't be obtained from thought or general conversation outside of therapy?

I don't think a "brilliant rational mind" is a prerequisite for coming to the conclusion that you're spending money to lock someone in conversation with you - someone that would not associate with you otherwise. To me, the relationship is artificial and the lessons learned can be obtained for free. Therapy seems to be conversational prostitution, more or less.

But you and others affirm that therapy has a positive ROI, and some people recommend therapy with such vigor you'd think it was the only (or the best/most efficient) way to get that return. I just don't see it, and to date I haven't met a sufficiently elucidating explanation.

A therapist is trained to spot things you miss.

It's like asking, "what does a junior engineer get out of being mentored by a senior engineer that they couldn't just figure out by coding or reading blogs?" A therapist brings things like context, breadth of knowledge, and honesty. I felt like the therapist wasn't incentivized to sugar coat things to spare my feelings, something close friends and family might do.

I am not sure about seeing one for 5 years, though. The point of a therapist is to make themselves unnecessary, in my opinion - they're supposed to give you the tools needed to do exactly what you're saying people should do - understand their behavior and change it.

I agree that seeing a therapist for 5 years may indicate they're not actually helping you progress.

I could offer a different data point, but since it's all subjective experience anyway, just make your own call. I've enjoyed long-term therapy because I found more things I wanted to work on. Ironically, it is my therapist who reviews things on a regular schedule and asks, "why are you coming to therapy now?"

(If your therapist isn't doing that, maybe that's a red flag that you are being taken advantage of?)

> I agree that seeing a therapist for 5 years may indicate they're not actually helping you progress.

It may also indicate you really need the therapy. That's the conundrum.

You need sometimes assess (reflect), possibly with your therapist, how they are aiding you effectively. In The Netherlands, there are waiting lists for psychiatrists (and a shortage), as well as waiting lists for specialized psychologists; hence they get paid either way. They'd rather have a client who benefits from their therapy.

If you think of a therapist as less "surgeon for the brain" who exists to fix issues and more like "personal trainer for the brain", then it makes more sense to have one long-term.

It's less about fixing things that are profoundly broken and more about incrementally trying to make the most of the brain you're given.

> I just don't see it

That's half of the point right there. You only know all the thoughts you will come up with. You go to a therapist because a good one will tell you things you never would have considered at all. Your mind has ruts so deeply worn you don't even know they are there. A therapist will nudge you out of them.

I've had a number of therapy sessions where my therapist said something about myself or my past that I literally had never considered in my entire life.

The other half is that good therapists have a lot of training in how the mind works and the tricks it plays on itself. They know to look for patterns where when you say X the problem is really Y, which is a connection you yourself have never made.

It's like asking "Why should I read this book? I'm not aware of anything in it that I don't already know." The point is that you don't know what you don't know that's in it. You can't accurately simulate a therapist in your head because your simulated one only knows the things you already know. An actual therapist will provide novel insight.

You are not a rational being. You are a bundle of emotions, patterns, habits, and semi-randomly locked-in sensitivities and responses.

Talking to a therapist does two things: it makes you interact with a human being, not an abstract concept or idea. This uses different areas of your brain, different cognitive and emotional pathways than does reading a book or simply "thinking about it"; and it allows you to receive the benefit of trained expertise in detecting what patterns, triggers, traps, and skills you have or need to have exposure to.

Calling it 'conversational prostitution' isn't really an accurate analogy; or rather, it shouldn't be if you're taking the therapy seriously, though a lazy therapist/patient couple could certainly devolve into something more like that. A prostitute provides a luxury service; a therapist is more like a business consultant, as you are both expected to put in work to understand the problems and work together towards solutions. So, sure, you could try to find the solutions yourself, but you don't know what you don't know, or even if you do generally know what your problems are, there's still an opportunity cost in building up the psychological domain expertise to fix them 'in house', when you could expedite the process by bringing in an expert.

A therapist can confront you as a human being in way that no book, friend, or family member ever can. There are often truths about being human that one has difficulty accepting on the basis of logic. A trained human being can find a way to make those truths acceptable.

The point of therapy is not to teach you, but to heal you.

The problem is we all carry around a lot of subterranean shame, fear and guilt, and your mind has a way of blinding you too it because those feelings are too intense to handle on a day-to-day basis. As a result, we all have blind spots and dysfunctional habits that we will defend at all costs. Haven't you met brilliant, highly rational people that keep acting stupid over and over again because they refuse to acknowledge their own problems?

We're all a little broken for emotional reasons, not rational reasons. Everyone knows they shouldn't smoke, and drink too much, and spend too much. But lots of people have problems with that, because it's not about a lack of knowledge.

A therapist, over time, gets you to open up, accepts you, and thus shines light on those dark places. When you accept them instead of reflexively rejecting them, you can actually see yourself with more clarity and thus behave more rationally.

So yes, you could learn whatever a therapist could teach you from reading books. But the benefit of a therapist is the relationship. You could also go through the same process with a good friend, but most people are bad at listening and being accepting, especially when you're sharing your deepest secrets. And sadly, most people don't seem to have the time. Haven't you ever tried to share something with a friend, but then they say something judgmental and you never show them that again? A therapist is trained not to do that.

Here is another helpful idea, hasn't been mentioned explicitly: a therapist has (or has had) many clients. For that reason alone, even if they had no more skill at coaching than your average friend, they have valuable insights.

You might think that you are very unique, but often that's not the case. Or, at least, your behavior can be decomposed into patterns, and a therapist can often forecast where that behavior leads (and, if they're skilled and/or lucky, where it's coming from).

There’s an interesting statistical observation that the kind of therapy seems to matter less than the relationship between therapist and patient. We are social animals a neutral experienced observer helping us identifying current problems and behaviors is much more impactful on an emotional level than a book. Narcissism is not an intellectual construct it is an emotional construct.

One example: we have our unconscious and sometimes we hide things from ourselves and strongly resist any attempt from ourselves or other people to expose that stuff.

Psychologists are experts in defusing such resistance and helping us work with that unconscious content, content that most people probably aren't very skilled in helping with.

Is not that a therapist will say or make you see or provide with a new angle to see things.

What a therapist does is to help you to ask and answer questions by yourself. Sometimes just the fact that putting things into words to a stranger is enlightening. A therapist might ask "why do you think you need to reason in terms of money, ROI and investment when talking about relationships?"

How I know this? I'm seeing a therapist too! I see her everyday. I've been married with a psychologist for 15 years now. I've been hearing these kind of questions forever!

> conversational prostitution

Do you grow your own food? If not, you are partaking in prostitutional farming.

Do you make the write the books you read? If not, you are paying for prostitutional authors.

"Conversational Prostitution"?

Are you saying if you were more attractive/deserving/whatever, people with therapeutic skills would go around sharing their insight with you for free?

I believe that's called a "friend". They might not necessarily be as good at it but they are doing it out of genuine concern for you

Sure a therapist is better than books but it’s not true that everyone is broken, that’s the equivalent of saying everyone is sick and should be on medication. Everyone has issues but having a balanced life with lots of social interactions is enough for the majority. And sometimes if you don’t have that the therapist become a substitute but that does not mean you are broken. It’s interesting to see a therapist like a doctor for a check up though.

What are examples of problems you couldn't solve with your mind?

  Broken heart
  Broken leg
  Blindness
  Losing a child
  Having a low (or too high) IQ
  Having severe mental disorder(s)

This is what happens when you run country music through lossy compression.

Needs a "Broken truck" line.

Ok, this was funny.

There's no such thing as an IQ too high. This is always some other problem like anxiety.

Ever been in a relationship? There are a lot of problems you can’t just solve with rational thinking.

Problems which can't be expressed as a ratio.

So the real problems.

And complex ones.

Are you saying all problems are imaginary ?

When you get to the root of them, yes.

Emotional intelligence and empathy are still part of the mind.

The original comment mentioned rational minds, which is relying on neither of those things.

Rational was an adjective. If you think that "rationality" is some objective feature that humanity can separate from emotions, you are deluded.

This reply somehow gets and misses what I was trying to get at.

No, of course I don't believe rationality is like that. The implicit point was that many people in tech do have an attitude like this. They overvalue their "objective" rational reasoning, ironically due to irrational needs.

Any that involves interaction with multiple people; you cannot predict others, especially since most people don't always act fully rationally.

I think people say that others dont act rationally, when really they just don't understand the other person's goals and how their behaviour contributes to their goals.

If i pass up $100 to get a burger, am i acting irrationally? It depends if i'm hungry. It depends how much $100 means to me (Am i bill gates?). Its impossible to say from the outside. I'm convinced much behaviour is basically the same except much more complex with multiple conflicting priorities.

No, people really just don't think rationally. Read Daniel Kahneman. It's been studied extensively.

No one always acts fully rationally

-Job loss -Romantic losses -Self compassion -Self care

Conceptually, think about how many times your friends have an issue that seems trivial for you (on the outside) to fix. Surely the same applies to you. Especially if you're high functioning, by definition anything left to work on is relatively outside your awareness and can't be solved from the "inside".

You need blank lines for the pseudo-bullets to not combine together like this.

(Caught my eye quickly scrolling down because they look like java command-line options)

Some 80% or so of worlds’ problems are human interfacing problems than mathematical-engineering challenges, and its best to exploit native ability to handle it that we all received when born.

World peace.

I'm going to counter the "therapists are great" theme that I'm seeing here. I think they're a waste of money. Cognitive behavioural therapy is a great tool. With practise and courage you can use it to reform the way you think. It won't fix something like schizophrenia but it might be useful for a narcissist who wants to change.

> It won't fix something like schizophrenia

Your comment is terribly unhelpful. Therapy isn't about "fixing" someone, but to help individuals with issues that negatively affect their life find opportunities to manage those issues. CBT is not something you can start doing by yourself without an external catalyst.

I have ADHD, OCD, and bipolar II along with recurring bouts of PTSD from a terribly traumatic childhood. Without therapy, I would have considerable more issues integrating with my peers and navigating the emotional turmoil that is the battlefield of my brain. Therapy has assisted me in shifting my perspective and enabling me to live my best life despite the demons that seem to constantly want to drag me down.

> CBT is not something you can start doing by yourself without an external catalyst.

I disagree strongly with this part. The "Feeling Good" book by David D Burns, which is essentially a fantastic primer on CBT, single handedly helped me conquer my depression in college and helped me graduate with high scores, just when I was on the verge of dropping out. It was god send to me because I couldn't afford to go to a therapist. (And depression was just one of the psychological problems that I had, which later therapy helped me identify).

> CBT is not something you can start doing by yourself without an external catalyst.

Sure it is. Self-therapy is useful, getting a therapist is useful.

Why is everyone shitting on other people's vibe?

> Why is everyone shitting on other people's vibe?

Because people provide horrible advice like this that prevents people from getting the help they need. Stigma is a real thing.

> I think they're a waste of money.

This is a valid opinion, but it would be better presented with some evidence to support it.

When someone says "A therapist really helped me." then their opinion carries its own evidence. They are a living evidential proof of their claim. (At least, to the degree that you accept that the commenter is honest and able to correctly measure their own quality of life.)

But when you say "therapists are a waste of money", your claim shows only absence of evidence, not evidence of absense. It may be that therapists aren't good for you, or that you haven't had a good one, or simply that you have no experience with them at all.

>When someone says "A therapist really helped me." then their opinion carries its own evidence.

that's only true for individuals which you do not believe to be affected by choice-supportive bias[0], which is , more-or-less, non-existent as far as humanity is concerned.

If someone buys therapy, and they feel as if their quality of life has been improved by the purchase, great, but that's not a quantifiable justification of much without normalizing out inherent bias in the decision making process; a process that isn't as simple as 'an opinion as evidence'.

[0]:https://en.wikipedia.org/wiki/Choice-supportive_bias

If the goal of therapy is a subjective increase in quality of life, then whether it comes from bias or objective change doesn't really matter. If the happy pills make you happy, it's sort of an implementation detail as to whether or not they are actually just a placebo. Perception is reality when the goal itself is subjective.

Plenty of clinical psychologists use CBT in practice.

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