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Comment by planck01 | Hacker News Reader

"To complicate matters, numerous studies over the past few decades have reached what seems a counterintuitive conclusion: that all psychotherapies have roughly equal effects."

The article gives a number of possible explanations for this, but not the obvious one: that the effect of psycho-therapy right now might not be more than a placebo effect. I wonder why this could not be the case.

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Or just the simple salve of talking to someone (who is payed to listen to you intently). We are social creatures after all.

I think it's because of the quality of the alliance, this is of course also what the article argues. According to my memory the studies have the same effect because of the therapist, not because of the placebo effect of the method. If it would be primarily a placebo effect you'd expect non-empathic therapist to do just as good.

I think CBT therapy scored better on average, so in that case it's not only the therapist but also the method.

I can understand the relationship between the two is what makes the difference. But the framework and the tools must as well.

Given the same level of trust, empathy, communication, etc, one form of therapy should give different results than other. They can't all be equal.

Unless ofc none of them do anything. I can find no other possible explaination.

The framework and the tools are mechanisms for establishing trust and for eliciting feelings and sensations. But it's the rapport with the therapist that seems to matter the most.

> They can't all be equal Unless ofc none of them do anything.

I often think of my therapist like a personal trainer. If you get a personal trainer, and go regularly, you will get fit. The particular workout they use does not matter so much as just going. Maybe one trainer would improve my cardio more, another would make me better at lifting weights and burst strength. Either way I am going to be healthier for going.

Running and weighlifting clearly net different results. So no.

Different patients have different therapeutic needs. So yes.

More specifically, just like some clients of a personal trainer may need to lose bodyfat and some may need to gain muscle, implying that cardio may be indicated for some people and weightlifting for others; patients with different therapeutic needs may benefit from different therapies.

Weightlifting increases your resting metabolism, while cardio burns more calories per session. If you were doing either of these in the right ratio, and sampled weekly for total calories burned, you would not be able to tell the difference between the two.

Similarly, I'm not arguing that there is no difference between different therapies, just that the way we measure is only able to say the equivalent of "most types of regular exercise result in increased burning of calories"

Calories burned is just such a small part of exercising, weightlifting and running have massive differences in results in all other areas. Saying you can't tell the difference between the two is just ridiculous, I'm sorry.

But ok, let's just focus on the single aspect that makes your argument hold a drop of water: calories. If you try to burn as much calories with weightlifting you will end up at least overtrained if not injured (thousands of calories per day eaten by PED users does not count). Running on the other hand can get you to Auschwitz physique pretty safely.

Which brings me to another massive difference: the failure scenarios of both techniques. You can get injured and harm your health in completely different ways. Weight lifting has vastly higher injure rates. What about therapy? There is something that can influence you but only in a good way? No way to over do it or do it wrongly? And all techniques are equal in this regard as well? I can tell you another thing which has these properties of "all are equal, nothing can harm you": homeopathy. Because again, it doesn't do anything.

I have worked in psychotherapy research. One way the possibility you raise is dealt with is by comparing what goes on in successful therapy with what goes on in unsuccessful therapy.

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