Does therapy actually work? I’ve always been under the impression that it was mostly placebo, and that only medication produces meaningful results. Happy to be proven wrong though
I don't know what to feel when people around me say I ought to talk to a therapist, leaving it as the only possible option for my mental salvation or outright refusing to listen to me about certain topics by saying the therapist needs to hear it, not them, only for the therapist to say they don't know how to help me. That is because I went just because someone told me to, because they did not want to listen to me, so I'm not motivated enough to get the most out of each session.
I started going with the intention of receiving CBT and I'm not sure if what we do can even be called that anymore after all this time. About the only reason I see my therapist each week is to have one person who is willing to listen to me in person instead of zero, and nothing particularly changes as a result. If seeing someone in person each week who is actually willing to listen is all that prevents me from becoming depressed, then it is a net positive result, but it is not life-changing in any real regard because of my lack of motivation or inability to properly utilize therapy.
Therapy is a lot more work for the patient - more time consuming, more costly, can be emotionally taxing in the early stages, etc. So I understand the desire for a meds only solution, and in some cases that is possible. But talking about therapy more generally I would encourage anyone who can to give it a try, just as I would encourage people to put effort into their diet, exercise, etc.
Obviously make sure it is evidence-based therapy though, something like CBT that has been well-studied. There are flavors of talk therapy that are total pseudoscience.
Therapy is actually a wonderful adjunct to medication because it helps instill lasting behavioral changes. A lot of people mistake the early motivational boost of stimulants for ADHD remission, but once the energizing effect of stimulants disappears due to tolerance, they’re left with the same bad habits they started with. Therapy can help build a better foundation for when the energizing side effect of stimulants disappears and only the attention-enhancing effects remain.
A lot of doctors start patients at crazy high doses (over 10mg) and a lot of patients do indeed benefit from 50+mg.
If medication isn't tolerated, starting therapy early seems like a great idea.
I don't think placebo is relevant in the case of therapy because placebo itself is a psychological effect.
CBT seems to be somewhat effective but with these things people's experiences vary a lot.
CBT does perform quite well repeatedly in these sorts of experiments, particularly for depression (it is less studied in some other disorders although still promising). You're right there can be a lot of variance between people though. There can also be additional variance IRL due to therapist quality IMO.