The Psychotherapy Myth | Hacker News Reader

The Psychotherapy Myth

aporiamagazine.com

99 pointsmpweiher233 comments

This is a weird article, and one of the weirdest features that leaps out at me is that they are treating "psychotherapy" as a monolithic thing to discuss and be studied. There are, of course, many forms of psychotherapy, such as CBT, EMDR, IFS, etc. etc. So I don't see how any one monolithic study of "psychotherapy" can evaluate its effectiveness, even if they are going to focus solely on depression, and indeed, this article only addresses depression.

Furthermore, of course, depression does not occur in a vacuum, and in my case it was the tip of the iceberg, and future sessions would progressively refine and broaden the diagnostic landscape.

Most of all, the positive experiences I have gained from psychotherapy are not simply talking to a professional guy and having him validate my feelings, but rather I've learned practical tools for coping and alleviating symptoms. You may work out of this year's depression, only to find yourself depressed again in five years. If you had taken drugs, then you come crawling back to the psychiatrist and the pharmacy again and you get back on drugs. If you had taken psychotherapy, then you may not need to return to the psychotherapist, if you have been equipped with the right tools, you could have them in a notebook still, and then you just do some checklists, you follow steps, and you've got your skills for coping back at your fingertips again.

Granted, I don't believe that psychotherapy is the be-all-end-all of curing mental illness. In fact, psychotherapy was invented in competition to, or perhaps as a replacement for, auricular confessions to a Catholic (or Orthodox) priest. The Protestant Reformation had eviscerated Germany's ability to cope with the mind's inmost challenges, and the common people had lost their most trusted human confidants, the ones who ministered in the person of Christ. So Freud and his Freunde came up with a way to whisper secrets to a man, have them held in confidence, and maybe even get some advice in return. But essentially, it was just a secular façade to compensate for a sacrament which had been efficacious for thousands of years.

The variety of psychotherapeutic approaches is discussed in the article. You can just ctrl+f for "cognitive behavioral".

I agree with GP after investigating your response, TL;DR: because it's very narrowly true: mentioned once, can be found via [searching the article].

Investigation revealed the context of this single mention is a claim that it is a lie to say the modalities are different. This context is created for a claim that [recent metastudies] showing therapy effective are falsified, proof being the modalities are all moderate to high effectiveness.

The reading of it is a polemic against a They, starting as "experts" in the subtitle and continuing throughout, leaving a generally correct GP versus a narrow claim that a modality name is mentioned once.

If you mean to observe that the authors literally typed the string "cognitive-behavioral therapy" into their draft, then yes, they did that: the string occurs one time, in a list of modalities, linked to a paper that they propose shows that all therapeutic modalities have comparable effect sizes despite the fact that even the abstract of that paper says otherwise.

>practical tools for coping and alleviating symptoms

Can you share some of those or are they rather personal?

I practiced visualizations as a way of coping with overpowering emotions. For example anger as fire which can then be extinguished, controlled

I don’t remember everything from my sessions, but in case of my severe anxiety we used text logs of (date, emotion, situation, initial thought) and my “I/they must” attitudes. Eventually we found a set of automatic (unconscious) thoughts that led to the symptoms. Once I started to root them out, anxiety reduced and panic attacks stopped completely.

Collecting this info was a homework because you can’t do it right in a session. The final homework was to consciously break “I/they must” attitudes. Specifically, I intendedly was several times (1) late for something, (2) went somewhere completely unprepared. As you may have guessed, I had two separate anxieties of being late or unprepared (among others). Ofc it’s not that I’m always late or unprepared now. But my own pathological anxiety feedback loop is no more in these cases.

These methods aren’t secret and every <insert type of psychotherapy here> book describes them in detail. You don’t even need to go to a therapist to use them, like you don’t need a programmer to use scandisk or memtest. But detecting inconsistencies in yourself is much easier when you talk to a different person.

In addtion to sibling three simple ones and a book recommendation:

Observe your thoughts.

Replace B/W "all or nothing" thoughts with logically correct ones.

Wear a rubber band around your arm. Every time you have counter productive thoughts, snap it lightly. Their frequency will go down.

The Happiness Trap by Russ Harris. It is about the very effective Acceptance and Commitment Therapy.

I second the Happiness Trap.

I don't know your reasons for asking, but we are not therapists, we don't know you, and I implore you not to try anything in your free time without direction and guidance from a professional who's charged with your care.

I can assure you that a great majority of practicing Catholics do not treat confessions seriously. Coming from a traditionally Catholic society, we don't have any better coping techniques than "simply man up".

I'm fascinated with Americans who discover Catholicism though. Suddenly the religious parts of Europe become what Japan is to anime enthusiasts - a mythical land of perfection.

> I'm fascinated with Americans who discover Catholicism though.

Catholicism is the largest single denomination in the United States.

> Suddenly the religious parts of Europe become what Japan is to anime enthusiasts - a mythical land of perfection.

Not really; very few American Catholics, cradle or convert, mainstream or “trad”, idealize “the religious parts of Europe”. American Trads idealize a fairy-tale vision of pre-Vatican II Catholicism which they are very aware does not reflect the present of Europe, and most American Catholics don’t idealize any particular alternative time and/or place in human history, current or past, real or imagined.

Focusing on denominations is a bit misleading, since some Protestants are anti-denominational (i.e., they reject denominations as wrong, which is kind of like Roman Catholics, except those Protestants go from one to zero ;-).

By affiliation, Protestants make up 66% of Christianity-derived religions in the US. 29% are Roman Catholic. Evangelical Protestants alone are 36%. (Source: https://www.pewresearch.org/religion/religious-landscape-stu...)

Religious affiliation is also highly geographically variable in the US, so many places would have relatively little cultural awareness of Roman Catholicism.

Therapy in combination with the right medication has shown higher effectiveness long term than each alone.

> In fact, psychotherapy was invented in competition to, or perhaps as a replacement for, auricular confessions to a Catholic (or Orthodox) priest.

Thank you for showing me a positive aspect of Catholicism. Their 7 deadly sins are just symptoms of people trying to numb their emotional pain for me. Shame makes people feel worse though. The threat of eternal punishment in an imaginary hell is a lousy deterrent to bad behaviour.

The words ascribed to Jesus, whos' story was written down 40 years after his "death" for the first time, work well though. Forgiveness works, the person that practices it benefits the most. You can do it for purely selfish reasons, to stop burning your energy being angry at people. Even if you practice Satanism after Anton LaVey, the first religion without a god.

If you want to hear people trying to numb their emotional pain, stop looking at the 7 deadly sins and start looking at the Stoics. Ancient or Modern

For what it's worth, Catholic priests specifically remind people (the few who go) not to treat Confession as a therapy session. The purpose of the sacrament is different from talking out your problems.

Very misguided and science denying.

Psychotherapy is about the relationship. This point is of such importance, that in Germany (where psychotherapy is covered by the mandatory health insurance) patients are allowed to have a couple of test sessions with several different therapists and then choose to continue with the one they feel best.

Also - as already pointed out - there’s a multitude of schools or types of psychotherapy (CBT, Psychodynamic, etc.) with statistically significant benefits. Of course, some are more suited for some cases than others. The OP treats psychotherapy as a monolith.

One way to look at it, is, that many people weren’t raised with competent-enough parenting (or mentoring) to acquire the skills to cope with some issues on their own - i.e.: the “just deal with it”. And this is the role of the therapist: not to become a parent, but to play the prosthetic role of a very competent parent, or mentor. So that the patient can increase self-awareness, self-reflection, and emotionally grow into being able to better deal with the situation at hand.

However, perhaps the biggest takeaway message here is that we need to educate Society - as we educate kids to learn to recycle - on how to choose a good therapist, what good therapy feels like, the importance of accredited and evidence-based methods (so people don’t rely on astrology and other quacks for - and therefore avoid properly dealing with - their emotional health needs), as well as, what should NOT happen in therapy sessions.

PS: And also educate about what is black & white thinking ;)

If psychotherapy is not a myth, what is the exact mechanism that therapy fixes an issue? If it were science that answer would be readily apparent. I can say exactly how photosynthesis works using chemical structures at every step of the process. But I can’t look up in a book how precisely psychotherapy fixes depression. Psychology has a dearth of actual repeatable testable experiments, which is why it’s not a science.

If so many people lack parenting that gives them the skills to tough it out and deal with it, that psychotherapy is necessary, why were so many people able to function prior to psychotherapy? Psychotherapy is only 100 years old, hell it’s only been socially acceptable for like 20 years. But people functioned just fine.

>But I can’t look up in a book how precisely psychotherapy fixes depression.

Well, you can for CBT. CBT goes by the assumption that a lot of depression comes from negative thoughts and it tries to change the way you think and therefore the way you feel. And CBT is the most scientifically backed up form of psychotherapy. So it looks like that works.

Sure, we don't fully understand the brain yet, but we are making progress.

It took almost a century before we figured out how photo negatives worked chemically. Didn’t stop anyone from taking photographs though. Mechanistic explanations are great but not a requirement for good science.

> It took almost a century before we figured out how photo negatives worked chemically. Didn’t stop anyone from taking photographs though.

That argument is a strawman as it works with anything that can't be falsiefied.

People who believe in astrology/chakras/etc. will also frequently tell you science will "one day" discover that "it's true". "We're just not there yet."

Also consider what someone may say in a hundered years:

It took almost a century before we figured out that psychotherapy didn't work. Didn’t stop anyone from taking pshychotherapy though. ;)

The point is that we can verify whether something works (with a randomized controlled trial) independently of knowing why it works, and psychotherapy interventions are commonly evaluated with RCTs.

Psychotherapy presents itself to experimental falsification [1] with epidemiologic studies, whereas astrology/chakras/etc., do not.

(Obviously, Psychotherapy is not a magic-bullet. It is however a valuable health tool to have available, and society should be educated - also on recognizing good and BAD therapeutic practices! - on how to use it, and destigmatized.)

[1] https://www.cambridge.org/core/journals/epidemiology-and-psy...

The basic problem is that you can't do double blind studies. Because the very same person would need to be once treated, once not treated and once treated with a placebo therapy. From the same "baseline brain state".

I.e. you can gather as much data as you want (referring to the metastudy you linked to) but you can't eleminate the inherent bias. People who are treated can not not know they are treated etc.

And while I do believe there is are a lot of forms of psychotherapy that work, I do admit (to myself for that matter) that this is based on belief. Possibly until we can simulate brains with a "sufficient resolution" (whatever that means).

You can't do a double-blind study with tobacco either. Or geology. Double blind studies are not the only source of knowledge

That's not how it works, though.

First, if it is not possible to blind the patient to the intervention and/or provide a meaningful placebo (which also happens with surgery and drugs with prominent side-effects) that's not a big deal, it simply changes the interpretation from "the effect of a particular regime of psychotherapy as such" to "the effect of a particular regime of psychotherapy, including expectation effects". Those expectation effects also exist in real life, if you go to a therapist you really really hope you'll get better and may be motivated to make a few changes in your life independently of the treatment, so if anything the trial becomes more realistic. Note that you'd still use a control arm so that if people get better over time without treatment, you're not exaggerating the effects of the intervention.

Second, almost every randomized controlled trial compares an experimental group against a control group, you are assigned to a group and don't move between them, and what that means is that we can only compare whether the treatment works on average, not whether it worked for one person in particular because, as you say, we don't know what would have happened (counterfactually) if that one specific person had been randomly assigned to the other group. But again, this hardly matters, because we can still know how well a treatment works on average. What you refer to, an experiment in which every subject receives every treatment, is known as a crossover design and while that design has its advantages, it's not that common because it is harder to pull off and while it can be more efficient (need fewer patients to attain an estimate with a given precision) it is not "less biased" or inherently more trustworthy.

> That's not how it works, though.

From the 'Conclusions' of Deaton and Cartwright (2018) [1], which is the one that seemingly comes up in debates among friends most often when this subject arises. I suggest to read that entire part of this paper at least -- it is very sobering. E.g.:

"[...] assumptions that RCTs claim to (but do not) avoid, so that if the aim is to use empirical evidence, any credibility advantage that RCTs have in estimation is no longer operative. And because RCTs tell us so little about why results happen, they have a disadvantage over studies that use a wider range of prior information and data to help nail down mechanisms. [...] Without knowing why things happen and why people do things, we run the risk of worthless casual (‘fairy story’) causal theorizing and have given up on one of the central tasks of economics and other social sciences."

I do not doubt everything in [1] applies even more so to RCTs in something like psychotherapy where the 'success' of 'failure' rests mostly on the interpretation by the subject and the 'why' is a black box. Until we understand and can observe brains in action much, much better and with vastly more detail than we do today that is.

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6019115/

The paper you link does not mention anything about the need to try every potential treatment (and no treatment) on every person in a study, and it does not mention anything about any "inherent bias" in RCTs -- these were the two claims you made -- so I'm not quite sure why you bring it up. Given that you have brought it up: I like Deaton's work a lot and know the arguments well, but you have to take into account that in this paper they are trying to provide some counterweight to a hype cycle that suddenly led a bunch of social scientists to argue that observational studies are stupid and should just be gotten rid of entirely and replaced by randomized trials, which for many reasons is not a good idea. That hardly implies that we can never know anything about whether psychotherapy works until we can simulate the brain, that's just a totally bizarre conclusion to draw from that paper.

I disagree: your baseline is a control group (or even the general population). They can answer a questionnaire screening for clinically-significant mental health symptoms (it's not difficult to find untreated people like this), and whether or not they have been to therapy before.

The mechanisms are actually quite clear, for example: Psychotherapy frontally tries to get the patient unstuck out of Dysfunctional Behavior and Maladaptive Coping Patterns.

One possible view is that Society has drastically changed in recent generations with industrialization, mass media & consumption, and minuscule families - it used to take a whole village to raise a child.

And to answer your final question, not so long ago, most people also did not know how to read and write, yet “people functioned just fine”.

…does that make mass literacy worthless then?

No, that's just the theory of CBT but there are other theories. Studies apparently shows that several psychotherapy types such as CBT are roughly equally effective despite having different underlying theory.

Would you claim that photosynthesis was a myth if we didn't understand every step of the Krebs cycle?

There are loads of natural phenomena we don't understand precisely, but nature doesn't care. We don't understand how many drugs work. There is no book that explains how thalidomide helps with multiple myeloma but is that a reason to say pharmacology is not science?

Not to be overly pedantic, but the Krebs cycle is a part of respiration, not photosynthesis. Maybe you're thinking of the Calvin cycle?

Exactly my thought!

You are appropriately pedantic. I learnt this in school almost 40 years ago, so apologies. The point still stands, I hope.

It most certainly does, and I didn't mean to detract from it.

> why were so many people able to function prior to psychotherapy?

Were they? If you look at statistics for harmful behaviours like heavy drinking or interpersonal violence, people in the West were absolute basket cases just 100 years ago by current standards. The incidence of such behaviours is much lower today than back then. A general awareness of psychology might be part of it. Not too long ago we were executing soldiers for cowardice after psychological breakdown due to PTSD. Think about how ignorant that is, compared to what we know today.

Anecdotally, mental illness runs in my family. I have the same personality / emotional instability problem almost all males on my father's side of the family have. He did better than most else of ancestors and I've done much better. And I chalk some of it up to psychological awareness of my parents and teachers etc. about how to work with that kind of kid. Good feedback at all stages. I think I would simply have been expelled from school in an earlier era.

> why were so many people able to function prior to psychotherapy

Can you explain why society being able to function prior to psychotherapy contributes at all to considerations about its efficacy and validity to science, or is in any way relevant to discussions about modern science? Walk me through your thought process here, because I'm similarly confused as to why we need all these antibiotics, for humanity survived just fine before they were invented in 1940.

Especially considering:

1) There are many documented cases of mental disorder throughout history that were either poorly-understood mislabeled.

2) Most psychiatric disorders don't have a completely-debilitating effect on those afflicted.

3) The existence of people being able to function does not say anything about the number of people who died/removed themselves from society due to being unable to interact. History is an interesting lens presented only by the people who succeeded enough to produce it.

> Psychology has a dearth of actual repeatable testable experiments, which is why it’s not a science.

Some sciences are characterized by their inability to perform isolated and repeated experiments with identical initial state: Economics, biology, climate, and anything based on humans. They’re still sciences.

"Very misguided and science denying."

Classifying a detailed article as either "science" or "science denial" is certainly black and white thinking.

I also don't think it's true that the role of the therapist is to be a mentor. I've had mentors, therapists, and parents, and those roles don't overlap as much as you seem to think.

Yet sometimes things are black and white.

"Yet sometimes things are black and white."

Have you had this fact checked by a cognitive therapist? They are, apparently, the arbiters of reality.

As a mathematician, I can assure you that some things are definitively black and white. The transferrability of mathematics to "real life" is questionable, of course. Axiomatic systems can only describe so much.

You might be suffering from a cognitive distortion, my good mathematician, I suggest you check with a cognitive therapist.

I'm kidding, of course, the joke being that whatever anyone says to me will result in a dismissal that only a cognitive therapist can know for sure what's real and what isn't, since they are the self declared experts on whether thoughts match reality.

Methinks thou doeth protest too much.

>Methinks thou doeth protest too much.

I love this argument. It was championed by Freud, I believe, and goes like this:

"When I say something and someone responds, there are two possibilities:

1) They agree with me, which shows I am correct!

2) They disagree with me, which means they are in denial, which proves I am correct!"

> since they are the self declared experts on whether thoughts match reality.

[citation needed]

> [citation needed]

Are you sure about that? You may be suffering from a cognitive distortion. I suggest you make an appointment with a qualified therapist.

No, it's pretty common practice to provide support for extraordinary claims. It's actually a normal behavior-- people usually don't respond with gaslighting, but given the level of other responses you've provided, this fits.

Am I gaslighting you and making extraordinary claims or are you catastrophising, making a selective abstraction, personalizing, magnifying, making an arbitray inference, overgeneralising, filtering, blaming, global labeling, discounting the positive, mental filtering, or jumping to conclusions?

I recommend checking with a therapist and finding out.

Yikes.

I have a better idea.

Get this book series.

https://www.amazon.com/Structure-Magic-Vol-Language-Therapy/...

One of the best reads I've ever done, and for the saavy mathematician/programmer who has a knack for deconstructing mental constructs via linguistic analysis, it'll equip you to be able to do better at handling your own woes, or at least being able to keep tabs on someone you decide you trust enough to allow them to engage in some neuro-linguistic programming.

YMMV.

Therapists have their uses. But to get the most out of them, you have to spreckin' the lingo. Then again, if you already can, you're more than half way there.

This actually looks like it might be of interest to me. Thanks!

Hi staticman2, have you been mistreated by a (CBT) therapist?

Allow me to constructively suggest you read up on Negative Countertransference: [1]

The importance of spreading information about what good therapy feels like, and what should not happen in therapy cannot be stressed enough.

[1] https://www.simplypsychology.org/countertransference.html#:~....

> I've had mentors, therapists, and parents, and those roles don't overlap as much as you seem to think.

I've been in therapy since 2010. Those roles do, in fact, overlap more than YOU seem to think.

I don't need studies to validate the hundreds of incredible results I've seen within the population I have direct access to (and myself)

Moreover, what's most onerous, if anything, about the psychotherapeutic mindset is the implicit "broken / fixed" distinction (usually framed as something like "health" or "well-adjustedness")

Another framing with regard to experience would look at "development," "growth," "abundance," "depth," "truth"

There is much to unfold and discover in this life, and psychotherapy is a sliver of a broader set of practices—which have been with humanity for the entirety of recorded history—for doing so deliberately

What's most interesting about this article is the demonstration of a high form of a certain current in conservative culture: intolerance for (read: anger and fear at) the "sensitivity" of others. The internal script is something like "I can't handle that other people are sensitive and lash out at me for how I am." The projection is self-evident.

A more accurate representation of the conservative position is that they just don't want to be forced to pay for psychotherapy for others, especially since there is very limited evidence that it actually works better than other treatments for certain conditions. I haven't seen any principled conservatives object to other people paying out of pocket for their own psychotherapy, even if they consider it ineffective.

Who are you addressing here? It certainly isn’t the comment you replied to.

I can conceive of a whole gamut of therapies which I'd rather not be funding with my tax dollars or insurance premiums, but my list is distinct from yours, and it would seem fairly individualized.

So it seems like the best solution is emerging: there are Christian Health Sharing ministries which impose requirements on the morals and faith practices of their members, and they also disallow sharing of costs for treatments which contradict or deny Christian doctrine, as delineated by the ministry's guidelines.

So, people are free to associate with a health sharing plan that is not insurance, and promises to observe the tenets of shared beliefs (Christian or not). It works more like a mutual benefit society.

In fact, there are a significant number of psychotherapists and other practitioners (natural medicine too) who do not accept any form of insurance. The health sharing ministries work with their patients to pay the bills.

However you'd find also thousands, millions in fact, of happy people who used the services of psychics, mediums, astrologers, crystal healers, taro readers, shamans, reiki practitioners, remote viewers. You'd also find millions who got cured with sugar placebo pills.

Which is not to say psychotherapists don't do anything right. Maybe they do something right. But it may be almost by accident, or maybe much is not needed for you to feel someone's got your back.

These trends, of solving a given problem a given way, are largely cultural. I wouldn't be surprised if one day we see present day psychotherapy as flawed as we see alchemy today.

I do not believe it is the case that you could find thousands, let alone millions, of people who have been cured of acute mental health ailments by means of astrology, crystal healing, or remote viewing. Further: your argument boils down to "there are sham cures, therefore all interventions are apt to be sham cures".

His argument sounds more to me like, "There are sham cures that have worked. Therefore this other thing that might work isn't conclusively not a sham."

People with "acute mental ailments" are treated by psychologists not psychotherapists (not the same at all), and are often put on debilitating drugs for the rest of their lives, not "cured". Never heard of people "cured" of schizophrenia or bipolar disorder etc. by psychotherapy.

Also, my argument doesn't "boil down" how you present it, you're severely misrepresenting what I said. The point is just because some people think it has helped them, doesn't mean it did. We're trying to attribute cause to effect, but we're often wrong about it. Our brain works by association, and associations are commonly misattributed.

This is why studying the field scientifically is important, rather than relying on "proof by testimonial". Especially the testimonials of fragile, suggestible people who would look for someone to lean on and trust by the very definition of their conditions.

And I meant psychiatrists up there, which is yet another thing. Sigh.

Psychiatrists often deliver therapy in some kind of modality, and refer out to therapists for other modalities. It's like the distinction between your primary care physician and a radiologist. They're distinct practices, but it's not like they're somehow adversarial.

I didn't say they're adversarial. The fact they neatly fill a gradient of niches, doesn't mean they're equally well supported scientifically, and equally useful.

There are still places where your doctor would send you to the local homeopath. Doesn't make homeopathy science. Or to the local priest to get exorcised. Doesn't make exorcism science. It simply makes them culturally accepted.

Cultural acceptance and science are not the same thing. Although often confused.

I don't know of any place in the US where a doctor would refer you to a homeopath. But virtually every doctor in the country would refer you to a psychiatrist, or directly to a therapist (one common way of providing mental health services is for PCPs to prescribe antidepressants and refer out for therapy), and virtually every psychiatrist would refer out to a therapist if they themselves didn't already provide compatible therapy modalities.

So no, I don't think this is a good comparison at all.

In Germany for example, homeopathy is covered by their healthcare insurance. I don't know why "in the US" is an argument. Space outside the US exists, and time outside 2023 also exists, and both those points in spacetime inform us about the culture we create as a species.

Just few decades ago you'd be referred for lobotomy in the US if you had... "unrest" I suppose. Or how about getting a red hot rod in the ear? Official cure for headache. But suddenly, here and now, we know everything, and nothing of anything we believe can possibly be false. It's always the same fallacy.

One has to be skeptical of everything, unless there are hard facts. Unfortunately psychotherapy is not hard science, by which I mean most of it doesn't lay in discovery following the scientific method in a rigorous, reproducible way.

In fact, the biggest component of the so called "replication crisis" comes from social studies, psychotherapy and psychology. It's full of papers proving "whatever" about human behavior.

> In Germany for example, homeopathy is covered by their healthcare insurance.

That's not true. Homeopathy in Germany is not part of official coverage. There are some select healthcare providers that refund some homeopathy costs, up to a few hundred euros annually, but the overwhelming majority does not even do that.

Sources on official policy and debates whether there should be reimbursements for homeopathy (the prior being: there are):

https://www.iamexpat.de/expat-info/german-expat-news/german-...

https://undark.org/2020/03/16/homeopathy-globuli-germany/

https://www.dw.com/en/german-health-insurers-urged-to-end-ho...

ECT is most definitely on the menu in 2023 around here, and I've discussed it with a few victims, I mean patients, who believe it's the answer to their prayers, and they must have their monthly zapping, or they just don't feel right.

> People with "acute mental ailments" are treated by psychologists not psychotherapists (not the same at all), and are often put on debilitating drugs for the rest of their lives, not "cured".

A prominent counter example to this is the treatment of PTSD.

> Further: your argument boils down to "there are sham cures, therefore all interventions are apt to be sham cures".

It absolutely does not. The GP dismissed the usefulness of studies and posited that personal anecdotes were sufficient.

If you think people haven’t or can’t be cured by astrology, psychics, shamanism, etc, I think you fundamentally misunderstand psychotherapy. The modern, clinical practice is just a controlled refinement of a process that has worked for thousands of years in thousands of ways. At an abstract level, it doesn’t matter what the method is, be it psychotherapy, astrology, psilocybin, etc. The benefit is in processing your thoughts to make sense of, and peace with, the world and the traumas it has inflicted on you.

> However you'd find also thousands, millions in fact, of happy people who used the services of psychics, mediums, astrologers, crystal healers, taro readers, shamans, reiki practitioners, remote viewers.

Maybe, and I know this seems like a crazy idea, we should look into that? It seems like a pretty big blindspot to dismiss all of that outright because the mechanism of action isn't yet understood or because it clashes with philosophical views that were common among some academics who died last century.

I don't think we dismiss that, but we attribute to the placebo (and nocebo) effect that is very real and still very poorly understood in spite of major efforts in the area. We know it exists, we know the factors that influence it, we know we can't really control it, but we don't understand the mechanism of action.

I suspect you could get the same benefit by paying some random nice person to talk with you for an hour about anything. Whether the topic is your star chart or home decorating or model railroads probably doesn't matter. There is a lot of evidence that frequent social contacts produce better mental health outcomes.

but you don't find random nice people. most people do not have the capacity or are not willing to empathize with the problems of others. especially as a man you are often not allowed to show vulnerability. these paid professionals are sometimes the only ones willing to listen and not laugh at your problems.

Yes, but being a psychotherapist is extremely emotionally taxing, which is part of the reason why it exists as a profession; try listening for a day straight of conversations regarding rape, sexual abuse, depression, anxiety, etc.

I wasn't referring to real licensed psychotherapists. My point was that if people feel like they benefit from talking to an astrologer then they could get the same benefit from talking to anyone else who's trying to help. The benefit comes from the social connection, not from the astrology.

These are all effective modalities in the right contexts. If you don't adopt a materialist metaphysics, it's easier to understand them, but it takes some time, effort and faith to gain access to the insight necessary to do that. Reiki is particularly easy to understand if you have a meditation practice—it's basically guided Vipassana from that perspective.

Another version that doesn't require endorsing esoteric practices is just acknowledging the effects of confession and things like faith healing, the "born again" phenomenon, etc. Here you see people reaching sustained ecstatic states through entirely mainstream Western practices.

Regardless, research does seem to show that methodology contributes very little to the effectiveness of therapeutic intervention. This is basically true in my experience. The most effective therapists have cultivated a certain quality of presence. If you want to look at it in a materialist frame, you could say they have a calm nervous system, which allows the clients nervous system to entrain to calmness and reinterpret challenging psychological material in an environment of held safety, similar to being held by a securely attached mother as a child.

Little about healing will be truly understood at the 'New York Times pop psych article level' of understanding until Western psychology fully integrates the insights of the great wisdom traditions, psychedelic medicine traditions, etc. This is currently happening very quickly and most advanced practitioners in the wild are well past the Overton Window.

Only one of the treatments you described has been subject to evidence-based approaches using the scientific method.

> I don't need studies to validate the hundreds of incredible results I've seen

<sigh>

> I don't need studies to validate the hundreds of incredible results I've seen within the population I have direct access to (and myself)

One would hope that most HN crowd would hopefully stop reading after this sentence.

Where to even start?

> Where to even start?

Maybe reading the rest of the comment is a good start

> Maybe reading the rest of the comment is a good start

The rest of it the comment is discredited by the line I quoted.

It already contains two biases verbatim. So that without even considering those that can be deduced/assumed further it can't be taken seriously.

Replace 'psychotherapy' with 'astrology' and reconsider OP's sentence:

"I don't need studies to validate the hundreds of incredible results I've seen within the population I have direct access to (and myself)"

Mind you, I am talking about the comment here. My opinion about the article the discussion is about is a tad more nuanced but that is beside the point of my reply.

> I don't need studies to validate the hundreds of incredible results I've seen within the population I have direct access to

We certainly wouldn’t want data to get in the way of our confirmation bias.

The more I learn about my depression the more I realize just how underdeveloped medicine is in this area. Everything that the author writes is true, some psychiatrists will even admit as much - i.e. that standard treatments such as psychotherapy or SSRIs or exercise work, but each of them just barely. We may be decades or even centuries away from reliably treating depression.

Most depressions indeed go away on their own, and perhaps are even helpful - they can force a person to reconsider and rearrange their life. The heavier ones probably have to be treated with everything that the patient and their environment can muster, all at the same time. And since the patient usually can't do much, it's up to the environment (friends, family, health care, mental hospitals). Please keep that in mind and force your depressed friends to go for walks, or do anything else at all, repeatedly. All the +5% basics like physical activity or smalltalk really do add up. Though the depressed person will not be able to see it for a while.

You (rarely) can force a cure onto people, and in the case of mental problem it's basically impossible.

If the science was clear in that depression would be heavily contained if the sufferer engaged in physical activity, good sleep, good diet, good general routine and zero stuff like social media or mindless entertainment, then how man people would actually follow through?

We criticize psychs for their love of giving pills, but we are the first who are lazy and stupid and would never actually do what's best for us

We might not be able to force a cure, but I can think of a multi trillion dollar industry (or two) that’s undoubtedly pushing the opposite. Maybe we should start there.

I had a pretty bad bout of depression about a decade ago. My girlfriend left me, followed shortly by one of my closest friends dying. I saw a therapist and went on antidepressants. I didn’t find either particularly effective or helpful.

I don’t know if it’s even possible for other people but what I ended up doing out of desperation was just logic-ing my way out of it. I would sense it coming and start directly countering thoughts and waves of emotions with reasons what I was feeling was not true and things I was grateful for. It was literally like arguing with my own thoughts and telling them to shut up. It shortened the bouts by a ton, stopped me from spiraling and eventually they stopped all together.

Maybe that will help someone else super analytical like myself? I genuinely don’t know. In more recent years, did not help my wife with her struggles at all.

That sounds a bit like you invented your own version of cognitive behaviour therapy

I do the same. Once in a while I remind myself of the five stages of grief/loss and I go explicitly through all of them to see where I stand now. Although I sometimes feel stuck, doing this exercise explicitly helps me to see I make progress. Progress as in 'two steps forward, one step back', but progress nonetheless.

Logic-ing or grounding is also something I recognize myself doing. And it can all be such simple accessible things to make it happen. For example, looking at a picture or video of my young nephews playing works wonders. Probably more than any talking session, although one has to also get the dirt work out of the way. The hard work of fixing stuff, and then relaxing by grounding work.

Have you tried ketamine therapy?

Ketamine is a valid therapy in Switzerland, but it's close to the end of what the medical system can offer. Along with electroconvulsive therapy and transcranial magnetic stimulation. Doctors do not recommend it for me yet (due to the cost of the therapy, i.e. the potential side effects), but they made it clear that I can try those options later.

But guess what - those methods also have a limited effect. Perhaps a bit stronger than the more common methods, but not by a lot.

K works until you run out of money. It was really helpful, and almost exactly counterbalanced by the amount of shit I had to wade through to get insurance to cover what they said they'd cover.

I think like many people, the first couple of paragraphs inspired me to see what else was published on the site for more “context” about the author’s point of views.

At this point, writing a good-faith rebuttal to the article seems unnecessary.

IMHO this article doesn't belong on HN.

There's a button for that!

why cant i downvote the post itself? is there a karma requirement for that?

No, you can't downvote posts, and if you use flags as a form of downvoting you may find your flags quietly defanged. In this case, though, I think you'd be on pretty firm ground.

Consider reading this: https://news.ycombinator.com/newsguidelines.html

> Comments should get more thoughtful and substantive, not less, as a topic gets more divisive.

> Please don't post shallow dismissals, especially of other people's work. A good critical comment teaches us something.

> Please don't use Hacker News for political or ideological battle. That tramples curiosity.

> Please don't pick the most provocative thing in an article or post to complain about in the thread. Find something interesting to respond to instead.

I'm as familiar with the guidelines as anybody on this thread so far (and I'm at least one of the people who suggested the first guideline you cite), I agree with the parent post, and don't see any way in which is contravenes any of these. This is a case where the provenance of the article matters a great deal.

Could someone explain? I’m unfamiliar with the publication. Asking sincerely.

After reading the comments here I first looked up the authors: https://rationalwiki.org/wiki/Bo_Winegard (there's also one for the second author, his brother). And then I took a look at the headlines here: https://www.aporiamagazine.com/archive?sort=new

At least for me that speaks for itself and supports what is written in this thread.

Thanks.

As someone who had one psychiatrist and two psychologists in his family, and having been myself in (very effective) treatment years ago, every time I read nonsense like that I immediately smell malice, this also because the vast documentation I read about Scientology during the late 90s and early 2K, which for those living under a rock, are among the most prominent enemies of psychology and psychiatry. The above link are eye openers; this at first seems a rather different case from cult scammers, as the guy is rather a far right extremist with the same mindset of antivaxers and Q-anon conspiracy theorists, ie someone who should ask for treatment himself, but at the end of the day it's just another case of someone with mental troubles who hates professionals whose job is to cure those problems.

At a glance it is defending its own definition of "great replacement" theory (i.e. it's a conspiracy by the left to cause the decline of the white population, but you know Aporia is legitimate and reasonable because they don't claim it's all orchestrated by the Jews--instead it's the "Elites"), lambasting diversity as some kind of "scam", and even espousing literal racism. Not even the dog whistling kind.

In this case, explain your dismissal. That’s it. Nothing wrong with having that opinion but don’t express it without actually explaining it.

bpm140's comment is extremely unsubstantive. It contains just vague insinuations. I clicked through to Aporia's contents page and couldn't figure out what bpm140's concern was.

The topic of the article is divisive, so according to the guideline you came up with, comments should get more thoughtful and substantive.

I am sure you can see why I reached the conclusion that bpm140 was not familiar with the guideline.

There's a chance I'm missing something here and, if so, I would love you to help me out by pointing it out.

I'm not saying you have to find it persuasive. I agree with them, you don't have to. But the guidelines don't demand that they say more than that, especially when the thread already makes it pretty clear where they're coming from.

Sorry, I'm not following. What is the substance of bpm's comment, and where is the thoughtfulness? According to your guideline it needs plenty of both, but I see none of either.

The article summary seems to be that an emotionally resilient person in a supportive community may not need therapy in response to an adverse emotional event. Studies and meta-analysis show that therapy is effective but it is possible that the effects are overstated. The author doesn’t suggest alternatives to therapy.

Personally, it is possible that there are supportive communities where coping skills are widely taught at an early age and that those skills are better for complex trauma than those developed by therapists (e.g. EMDR) but I am pretty confident those types of communities are far from the norm.

Wow, did the same as you, and eep...

> The demographic groups involved likely have an average intellectual quotient (IQ) under 85, an aspect that's seldom discussed openly in France. What is the cost of silence?

I'm all for evidence based medicine, but I don't think the authors could make me trust them less if they tried.

Under all the studies cited and the scientific analysis there's this subtle, yet clear, gnarly conservative discourse that can be summed up as "Therapy? Be a man, would you?".

And if that's not enough, there are all the ... I lost count how many, subtle logical jumps that seem reasonable for the sake of argument and brevity, but if you spend more than a second on it make you go "wait, that's right".

I'm not saying rationalwiki is an authoritative source but you might find it a useful starting point to learn about the authors: https://rationalwiki.org/wiki/bo_winegard5vg5

My suspicions were aroused when I saw they interviewed J. Michael Bailey, who has been doing science backwards for decades now to paint me and the people who saved my life as a bunch of deluded perverts.

The manifesto on "race realism" (!!!) is enough to convince me that the authors of this piece would shoot me dead if they ever got the chance.

They can kindly fuck off back to the 1920s with that nonsense.

Is that link correct? It appears to point to an empty page

https://rationalwiki.org/wiki/Bo_Winegard

While I have seen any kind of participation (hence quality and dubious patterns) in Wiki articles, this is what you find there:

> W spends most of his time on Twitter talking about _ and the alleged evils of _. He commonly retweets _ and other so-called _. W identifies as a member of the _ which is basically an attempt by _ to re-brand themselves as political moderates.[ref]

That is profiling work. (Not just "Ad hominem".)

The clash with the name "rational-wiki" is too strong not to be noted.

(Sniper, put some argument there: you are qualifying yourself. Not in a good light.)

RationalWiki is a highly biased cancel community which has attacked people like Scott Aaronson and Scott Alexander before.

That may be the case, but you don't have to believe RationalWiki's subjective assessments; you can just follow the links. In this case, they provide pretty straightforward support for the claims.

I find RationalWiki to be directionally useful, with maybe just a little bit of extra clicking. If they say somebody is, say, anti-vax, you can usually quickly determine from the cited sources whether that's a reasonable claim, or somebody willfully misreading an ambiguous statement on Twitter at some point.

Then why not instead link those (which?) links directly? Then we can perhaps discuss the evidence, e.g. this[1]. The fact that a research topic is taboo doesn't mean it is pseudoscience.

[1] https://forum.effectivealtruism.org/posts/ALzE9JixLLEexTKSq/...

Because they're already handily collected at the link provided.

Yes, I can also provide link lists, like the one above. So who's right?

In this case? RationalWiki is.

That's far from clear.

What's wrong with attacking Scott Aaronson and Scott Alexander?

You apparently think it's okay to attack RationalWiki, so what is the distinction?

RationalWiki tries to get people cancelled, unemployed, destroy their career prospects and perhaps ruin their lives. All the while they hypocritically and cowardly hide between their anonymity. It is disgusting.

It shouldn't be necessary to point out the difference between attacking a person and a movement/belief set/organization, but I guess it is.

Maybe you should point out what you mean by "attacking" a person?

I assume they were "attacking" (as in disagreeing with?) the belief sets of Scott Aaronson and Scott Alexander as outlined in their blogs?

They tried to cancel them for being considerers of heretical thoughts.

In every time period of the past there have been things which were taboo to discuss, which were outside the Overton window. There is no reason to believe our times are different in this regard. That's why intellectually honest people should engage by engaging with arguments themselves, whatever they may be, not by engaging in cancellation and character assassination.

I don't know enough about those two bloggers to comment in a fair manner, but I'll just say I don't think the distinction between arguments and character assassinations is as clear as you are drawing it.

If I think people born on a tuesday have no souls based on deductive reasoning, and invite likeminded folks to spread the word, is that an argument or a character assassination? I would say the latter, someone else might say the former.

> I don't think the distinction between arguments and character assassinations is as clear as you are drawing it.

It's certainly very clear in this case that the NYT conducted a character assassination of Scott Alexander, so I don't know why you're making this argument.

> I assume they were "attacking" (as in disagreeing with?) the belief sets of Scott Aaronson and Scott Alexander as outlined in their blogs?

You assume wrong. The NYTimes article on Scott Alexander (I haven't read the one on Scott Aaronson) attacked his character in addition to his beliefs.

Oh, and they doxxed him, which is categorically different than pointing out that RationalWiki does profiling and ad-hominem attacks.

Rationalwiki is just encyclopedia dramatica for people who feel holier than those using encyclopedia dramatica.

> I'm not saying rationalwiki is an authoritative source

Then don't fucking link it.

I'm not saying Encyclopedia Dramatica is an authoritative source but you might find it a useful starting point to learn about Rational Wiki - https://encyclopediadramatica.online/RationalWiki

Background on the authors:

https://rationalwiki.org/wiki/Bo_Winegard

https://rationalwiki.org/wiki/Ben_Winegard

Rationalwiki is trash.

How so?

It is by reputation very online, very judgy, and very left, so its pronouncements are perceived as cliquish and insubstantial. That's probably the case; it's probably a mistake to just go click around that site and draw conclusions according to what it says. But it is also a useful link aggregator, so when it claims something, like "this person earnestly believes that the Earth isn't round and that there is not an atmosphere but instead an atmosflat", it's worth checking the links to make sure that isn't clearly the case. Oftentimes it is.

I wouldn't call it "trash", but it comes with some political bias and personal vendettas.

The reason for both is that the entire wiki probably has about dozen editors, some of them way more powerful than others. So you might think that "wiki = something edited by lots of people", but for many topics there was one person who decided whether something was okay or not and wrote the article accordingly, and everyone else only added details afterwards (or disagreed and was banned).

From my perspective, the greatest problem is the local cultural norm that once you decide that someone is a bad guy, it is allowed (even encouraged) to exaggerate about them, and complaining about exaggerations can get you banned. Which means that when a mistake is made, it becomes very difficult to fix it, because of course after the exaggerations anything can look stupid.

Background on the authors according to a far-left website.

Let's at least be honest.

You can just follow the links in this case. I don't know much about RationalWiki and am disinclined to "trust" it, but often when that site makes claims, the links they provide to primary sources are more than sufficient to support them. That's the case here.

All the information about them is cited and backed up by evidence, the fact the website is left wing (according to you) shouldn't get in the way of the factual information contained within.

At least half of "information" is just guilt by association, sometimes taken to ridiculous levels:

"Winegard clarifies his above comment and concern is specifically only countries below sub-replacement fertility (2.1 TFR), meaning (excluding a few countries in East Asia i.e. Japan, Singapore and Korea), the whole of Europe.[33] This a key obsession of white nationalists (such as Brenton Harrison Tarrant, the perpetrator of the Christchurch terrorist attacks, whose manifesto called for white Europeans to increase their fertility rates above 2.1)."

Winegard says make more babies, you know who said that too? Christchurch terrorist! Ridiculous.

Do you think it's ridiculous to associate Bo Winegard with this race realism manifeto? - https://www.aporiamagazine.com/p/race-realism-a-moderates-ma...

Just associating is not enough. You need to explain why something is wrong, some things are obvious some are not. There is article about this on Rational wiki (https://rationalwiki.org/wiki/Racialism) where they present their opinion on Race realism.

By linking those two things (association with Racialism and debunking Racialism) you can "present a case" against Bo Winegard (although in imperfect way, the best proof would be to debunk his words, not associate him to the theory debunked in another article).

This ain't it; there's a debate to be had about the quality of evidence of the many different approaches to psychotherapy, but this person, this tone and this arguments are not it. You can watch people who know much more about the topic (which could be achieve by a more open-ended cursory search) here in the comments trying to elucidate points that are not even made by the OP, just out of the good faith of their hearts (and a desire to keep things on topic). But posting a self-fashioned race-realist certainly would repel most knowledgeable people with good faith.

Strawman, no one thinks that it is false: humans can be resilient and tough-minded; they can suffer the slings and arrows of life without expensive interventions from “experts".

Agreed. My understanding from someone I consider to be a very good clinical psychologist is that the only time you may need some psychotherapeutic intervention is when you are genuinely stuck with a problem you can’t figure out yourself _and_ it’s significantly hampering your quality of life in some way you consider meaningful.

And then, you only need help until you’re unstuck.

Teach a man to fish, and all that…

Right, but you hear "everyone should be in therapy" from all corners; there's at least one dating app (Bumble, I think) that has an "In therapy" tag you can put on your profile; and BetterHelp advertises themselves with a commercial where girls at brunch talk about a guy one of them has been seeing, and they agree she should stop seeing him once they realize he's not in therapy, even though they know almost nothing else about him ( https://freddiedeboer.substack.com/p/im-not-trying-to-be-dra...).

That isn't really a view of therapy as a specific intervention, but as an almost mandatory practice for adults, kind of like going to the gym. The view of the psychologist you mention is actually sadly rare. Obviously, I think the widely shared view of therapy is a total bastardization of any worth therapy might have had in the first place.

This thread is literally the first time I've ever heard "everyone should be in therapy" from anybody.

You must live on the moon. Just google "everyone should be in therapy" and see how many results you get.

I absolutely believe that I can Google for a sentence and find that many people have written that sentence. I am sometimes proud of myself when I come up with sentences for which that isn't the case. I'm not sure that you've demonstrated that I should have declared my residency as lunar.

Pointless answer. The fact that there are many articles making the argument that "everyone should be in therapy" means that this is not some outlandish and never heard of opinion like you imply, but rather a well established one that you weren't, somehow, aware of.

People can make up their own minds about the implications of me not having heard of something. I'm simply providing the data point: this thread is the first time I've heard someone say "everyone should be in therapy". That doesn't make a lot of sense as an argument, either, so I'd be surprised if it was all that prevalent a belief. But who knows?

While I don't believe "everyone should be in therapy" (nor have I encountered this attitude even as someone who believes in the value of therapy), the dating context is an interesting one with its own set of issues.

The reality for women on dating apps is pretty terrible, and therapy is a signal for "focused on self-improvement". In a dating pool filled with emotionally immature people, it can be useful to find other people who are similarly committed to self discovery/improvement.

And if you're dating in your mid 30s, a time when people are probably back in the dating pool because of a failed relationship, everyone is looking for evidence that a budding relationship isn't doomed to the same kinds of failure as the last one.

There aren't may ways to socially signal "I'm focused on (internal) self improvement and I'm serious about it".

I actually don't think it sends a credible signal like that at all. I've been to several therapists, know people who've been in lots of therapy (unavoidable these days), and I don't think it leads to much if any self-improvement. It can produce plenty of insights, but insights almost never lead to change.

Anecdotally, I’ve also been to several therapists, and after a few that didn’t fit, found one who focuses on the issues I’m dealing with, and the experience has changed my life. I have friends who have experienced the same. I also have friends who are frustrated by it all. Good care can be tough to find. This doesn’t invalidate the field, or the benefit of seeking help. I’d tell people to treat this like they would other life impacting health providers. Take charge of the situation, and leave providers behind who are not helpful. I do think too many people approach therapy like it’s a prescription. “Take this much, get this result”. I started with this mindset, and adjusted when I realized that it doesn’t make sense.

All of that said, the main point was that talking about therapy in a dating context is more nuanced than “everyone should be in therapy”, and that some people look for this signal for understandable reasons.

How credible that signal actually is, is another question. If you’re looking for “I’m working on myself”, that doesn’t imply an expectation that someone has reached enlightenment. Just that they’re trying to be better.

A large number of people don’t seem to try at all, so I’d still argue that it’s a signal worth considering. But like most signals, it’s just a signal. It doesn’t guarantee anything.

> Good care can be tough to find. This doesn’t invalidate the field, or the benefit of seeking help. I’d tell people to treat this like they would other life impacting health providers. Take charge of the situation, and leave providers behind who are not helpful. I do think too many people approach therapy like it’s a prescription. “Take this much, get this result”.

The problem was not, as you imply, passivity on my part and an expectation that the therapist would deliver results with minimal involvement from me (I realize you didn't intend to belittle or dismiss me, but that's what the implication was).

The problem was that the therapists were just plain awful. They would ghost me, use therapy session time for unrelated things, were attracted to me and couldn't deal with it, etc. When they weren't doing any of these things, "therapy" consisted largely of them trotting out empty platitudes, or doing roleplaying scenarios that I dutifully played along with but mostly found simplistic and pointless. Occasions on which something valuable happened were few and far between, and were always torpedoed by unprofessional behavior from the therapist that killed the therapeutic relationship (see the examples from earlier).

Now, ironically, your own post strikes me as therapist-like behavior: you assumed what the cause of the problem was (passivity on my end), even though that did not happen at all, proceeded to give me advice on what to do ("Take charge of the situation, and leave providers behind who are not helpful" -- a startling insight indeed); advice that would apparently be simple to do, and would fix my problem. This is exactly how the therapists I've had the misfortune to work with operated: they would assume the client's issues are due to failing to see a simple solution (perhaps because of their "mistaken beliefs" or "bad mindset"), would point that out, and would expect the issues to be solved and, usually, a dose of reverence from the client. This, of course, bears essentially no resemblance to what it would take to help someone deal with a genuine, serious issue.

All in all; your post, so reeking of the typical therapy mindset with all its incuriousness and condescension, only strengthens my belief that therapy is essentially worthless (except possibly for mild and superficial issues, e.g. if things are fine in your life but you have occasional panic attacks, etc.).

And to bring it back to the original point: Based on the above, no, I don't think "in therapy" signals “I’m working on myself” in any meaningful sense. Plus, the stance that it does pretty much vindicates the view that everyone should be going to therapy, as it implies that therapy is a generally useful tool to help you become a better partner, and just about everyone wants to send the signal they're a good partner.

While I'd like to agree with your points about the potential downfalls of therapy, and the troublesome implications of these applied at scale to the perverse incentives of a pro-therapy society, I cannot. Your tone is far too adversarial here for the kind of productive conversation I'd like to see or be a part of. That user's response carried none of the malice you attribute to it, and I believe you should reconsider how you address conversations like this.

The response was enormously condescending, for reasons I went into at length, so I think the tone was justified. That the response was worded politely doesn't really matter.

> While I'd like to agree with your points about the potential downfalls of therapy, and the troublesome implications of these applied at scale to the perverse incentives of a pro-therapy society, I cannot.

Sorry, but I think being able to separate tone from substance is something pretty fundamental for having discussions you can learn from, so I wouldn't have much to tell you on this score even if I agreed about the tone being too adversarial.

Now I would respect something like "I agree with your points, but please lower the tone". But saying "I can't agree with your points because of your tone" -- come on.

> The problem was not, as you imply, passivity on my part

I don't know you or the specifics of your situation, and I genuinely try not to make assumptions about other people. My comments were based on my personal experiences and conversations I've had with people in my personal life about therapy, and nothing was implied. The thought that passivity is what led to your own experiences never entered my mind.

To that end, I'm not responding to the other paragraphs that were focused on this misunderstanding. You experienced what you experienced. I experienced what I experienced. These things stand on their own, and the existence of one doesn't invalidate the other, nor was raising my experience meant as an indictment of yours.

> The problem was that the therapists were just plain awful. They would ghost me, use therapy session time for unrelated things, were attracted to me and couldn't deal with it

This all sounds absolutely awful, and incredibly unprofessional. I'm sorry this has been your experience, and the not-so-helpful experiences I had were more about the therapist's lack of trauma experience, and some other issues of treatment style that didn't work for me.

If I had therapists like the people you're describing...yeah, I can understand why you'd feel jaded about this.

And I guess that was the point of my anecdote - there are some good therapists out there. People should know about this. But it's just as important to be aware of the failures in the field. I saw my comment as building on what you were saying, i.e. that there can be situations that don't work, so be aware of that and adjust accordingly.

> only strengthens my belief that therapy is essentially worthless (except possibly for mild and superficial issues, e.g. if things are fine in your life but you have occasional panic attacks, etc.).

In my case, Complex PTSD from physical and sexual abuse as a kid (with a cornucopia of unhelpful extreme religious belief systems on the side). I experienced a period of suicidal ideation after years of nightmarish sleep issues. At some point it dawned on me that the only way through this was to confront my own mind. Drugs don't undo memories. Walking in nature doesn't come with education about how to stop ruminating on said abuse, or what to do when it makes an appearance every night in my sleep, etc. I'm sleeping really well recently.

If the issue is especially big, it's especially reasonable to need/get help.

And when I think about the state of mind I was in when I started seeking help, I can't imagine how my life would have gone if I had encountered the kinds of issues you describe. I'm grateful I was fortunate enough to find good care, and take seriously the fact that some people are not so fortunate.

Thank you for understanding the issue, sincerely. I've unfortunately seen lots of people defend therapy blindly, insist that any failure was due to either not finding the right therapist or "not doing the work", and take it for granted that you always have to go to therapy to recover from anything remotely significant.

The way I look at going to therapy right now is like having an oasis possibly hidden behind a minefield -- the oasis may or may not be there, but either way, you have to go through the minefield and the wrong move will blow your leg off, or worse. In those circumstances, trying to get to where the oasis -might- be is not worth it.

I'm genuinely glad you got effective help for what you were dealing with. It sounds truly awful, and nobody should ever have to bear a burden like that.

If you're ever interested in talking more about this off HN, you can contact me through the email in my profile. And also, if you're interested in reading more about therapy going badly wrong and clients' experiences of that, I can recommend the r/therapyabuse subreddit. I find that pretty much every post there speaks to me.

> It can produce plenty of insights, but insights almost never lead to change.

Insights by themselves can't won't lead to change, but they can be a starting point.

Look at it this way, say I am overweight and want to get in shape. The insight that I need to eat less and exercise by itself of course won't make me immediately fit.

But that insight combined with work and support might.

Also therapy, to me isn't about self improvement, it's about feeling better in one's skin. Often it not that the presenting problem even goes away, but that the way you relate to it changes.

> Look at it this way, say I am overweight and want to get in shape. The insight that I need to eat less and exercise by itself of course won't make me immediately fit.

> But that insight combined with work and support might.

Putting aside the fact that your example isn't actually an insight (diet and exercise as a way to lose weight is also something you hear suggested from every corner, although with more justification), the "insights" produced in therapy are supposed to lead to change largely on their own. That is, it's assumed the client already has all the resources needed but, poor dear, he's held back by flawed beliefs, which therapy is supposed to undo. Needless to say, this has little resemblance to reality.

> Also therapy, to me isn't about self improvement, it's about feeling better in one's skin. Often it not that the presenting problem even goes away, but that the way you relate to it changes.

Putting aside the fact that this kind of contradicts the first part of your post, where you argue for how therapy can in fact help solve your problems, sorry, this is pure cope. Changing the way you relate to a problem, in that sense, or reframing, is talking yourself into believing something bad isn't actually that bad. Auto-gaslighting with a therapist's assistance, really. I prefer to solve my problems instead of trying to trick myself into thinking they're not what they are.

Ha thanks, I love a good argument.

>Putting aside the fact that your example isn't actually an insight

So put it aside then, and think of your own better analogy. It changes nothing from the point I was making.

> the "insights" produced in therapy are supposed to lead to change largely on their own.

No one has believed this in a long time.

> I prefer to solve my problems instead of trying to trick myself into thinking they're not what they are.

So do I but sometimes things break, permanently.

I can't bring dead people back to life, if I'm injured or disabled by an accident I can't 'fix' that, but I can find a way to change how I relate to that unfix-able problem. This goes beyond re-framing, of course.

As to childhood experiences and trauma, they are real and often elicit means of coping which later become ingrained habits which can cause dysfunction later on.

Therapy can help you recognise these (insight!) and then start you on the long slow path of unlearning them so they don't cause you problems anymore.

When you see everyone in a Corn Flakes commercial eating Corn Flakes does it make you think that omnipresence of Corn Flakes is a broad social trend?

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Is this the first commercial you've seen where a company presents its product as something that will make your life better, or make you fit in, or make you more attractive to others?

Is this the first commercial you've seen ever?

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You went through the trouble to write a substantive comment but sabotaged yourself with the swipe you used to introduce it.

Why do you see it as sabotage? I don't, given the comments leading up to that one.

> you would, I hope, be revolted by a funeral company that advertised their funerals as a place to meet girls at a time when they're emotionally vulnerable

Of course it's stupid but I expect advertising to be stupid and I try not to pay attention to it. A company promoting therapy in a stupid way doesn't change how I think about therapy in general.

And if I see a dumb commercial about therapy I don't let it make me believe that "you hear 'everyone should be in therapy' from all corners".

We're supposed to be skeptical about advertising, not let it shape our view of the world.

The point is that they ran this ad in 2022 and it wasn't met with widespread ridicule or outrage (which happened with many, many other ads), which says a lot about the current culture.

> And if I see a dumb commercial about therapy I don't let it make me believe that "you hear 'everyone should be in therapy' from all corners".

Believe it or not, this commercial is not what made me believe that you hear that sentiment everywhere. What made me believe that was hearing it everywhere.

Here are some examples:

Go to therapy before dating https://www.reddit.com/r/dating_advice/comments/l2igvw/go_to...

> There are armchair diagnoses of celebrities and other public figures happening in real time, alongside tweets admonishing people who display troubling behavior with the phrase “go to therapy!” There are detailed fantasies unfurled in long threads about what the world might look like if everyone (but especially cis hetero men) went to therapy and worked out their issues — all of the toxic masculinity poisoning the wells of communication and paths to healing. https://www.nytimes.com/2022/10/11/opinion/therapy-america.h...

Why Everyone Should Try Therapy at Least Once https://www.shape.com/lifestyle/mind-and-body/why-everyone-s...

You broke the site guidelines repeatedly and badly in this thread, as well as in other recent threads (https://news.ycombinator.com/item?id=36923982, https://news.ycombinator.com/item?id=36736880). That's not cool. We have to ban accounts that post this way, because it destroys what the site is for. I don't want to ban you!

If you wouldn't mind reviewing https://news.ycombinator.com/newsguidelines.html and taking the intended spirit of the site more to heart, we'd be grateful. Fortunately many of your other comments have been fine, so this should be easy to fix.

Can you please follow the site guidelines when posting here? I'm afraid you broke them more than once in this thread.

https://news.ycombinator.com/newsguidelines.html

That link is basically infinity times better than the article we're all commenting on.

I agree! I submitted it when it came out but it kinda just sank.

> chief content of this myth is that people often cannot process or work through adverse events and traumas—abuses ...

It's not people often, it's some people sometimes. Not everybody gets traumatized by the same things, not everybody needs help to process them. But some need help and for some psychotherapy helps.

Every time I see such an article that dismisses psychotherapy, I cringe a little bit.

It is obvious that the author is ignorant of the topic (psychotherapy).

It sounds like a hardware engineer dismissing software engineers and strongly affirming that all bugs can be solved with hardware solutions.

Some problems are indeed due to psychic issues and not physiological ones. Yes, you can probably workaround symptoms with drugs, but that does not really solve the problem.

If you have mental blocks and a shitty life that makes you depressed, and alleviate the depression with drugs, you still have mental blocks and a shitty life.

I wish that both disciplines were not as independent from each other as it is today. Having experts at both subjects could probably do wonders to help people and make proper progress.

Option 1: Confront your mental blocks and shitty life with depression.

Option 2: Confront your mental blocks and shitty life with less depression (due to pharmacology).

Option 3: Confront your mental blocks and shitty life with a guide and less depression (due to pharmacology and therapist).

Option 4: Wait for the law of averages. https://youtu.be/3s_BqdZrUbE

I'm taking option 3 all day, every day.* (e.g. I agree with you. They should always be done in tandem / there is no silver bullet).

*It's very important that your therapist shares your zeitgeist or directly counters it as a devils advocate. The drugs... not so much.

Option 4: Convince yourself your life isn't shitty via self-gaslighting / culture. (Often achieved historically via religion. Listen to stories of Jesus' suffering at church once a week for your entire childhood and any suffering you go through despite your good behavior suddenly seems less bad when you compare it to the ultimate Good Person who was tortured and killed on a cross).

Option 5: Convince yourself it's worth suffering through your shitty life because if you're a good moral person, you can keep your eye on the prize (eternal afterlife in paradise with all your dead relatives and loved ones in eternal abundance and joy), also historically achieved via religion.

"According to their analysis, religion is positively associated with life satisfaction, happiness and morale in 175 of 224 studies (78%). Furthermore, religion is positively associated with self-rated health in 27 of 48 studies (56%), with lower rates of coronary heart disease in 12 of 19 studies (63%) and with fewer signs of psychoticism (“characterized by risk taking and lack of responsibility”) in 16 of 19 studies (84%)."

https://www.pewresearch.org/religion/2019/01/31/religions-re....

Every time I read a critique of psychotherapy like this, it's hard not to conclude that the authors have very little knowledge of what therapy actually entails, and how it's changed over the decades.

As someone who has dealt with mental health issues stemming from complex trauma for most of my life, it's difficult to take this seriously. What the author describes is a laughable caricature of the field, and seems pretty far removed from the realities that many people face.

I see therapy as a commitment to focusing on root causes, and retraining maladaptive patterns of thought. I see my relationship with my therapist as that of a teacher/student. Someone who can help me reframe things and see other perspectives until I can do the same thing for myself. Coming from an abusive environment that hammered certain attitudes into me from an early age, I've found incredible value from establishing a trust relationship with a person who can act as a conversational sparring partner and can point out the patterns of thought I can't see in myself. I didn't have other people in my life who I trust this deeply, probably because of the underlying reasons I'm seeing a therapist.

I've found that some of the most helpful ways to improve my mental state have nothing to do with those sessions. Sleep, exercise, time in nature, social connection, artistic outlets, etc. are all critical. But those are the things that I didn't know how to actually do. I wanted to want these things, but couldn't navigate the mental blocks that kept me stuck where I was. And for whatever immediate physiological benefit these activities bring, they don't undo decades of conditioned thought that needs to change. Using sheer willpower to force myself to exercise only worked for a short time, and I couldn't establish lasting habits until I had unwound associated unhelpful patterns.

To present these things as better than or as effective as therapy is to completely misunderstand the point. Therapy is also not some panacea, and most of the real work happens outside of session.

> Patients can expect to pay somewhere between 60 to 250 dollars per hour for a therapy session. (A jog in the park, a church service, a long walk in the woods are all, of course, free.) In many cases, insurance covers part of this; however, therapy can still be expensive for the patient, and therapists—men and women who often espouse dubious, even risible theories—are handsomely remunerated.

As a kid, I grew up going to church services. Services in which I heard "spiritual leaders" rail against the sinfulness of homosexuality (among many other things). Around age 12, I heard earnest conversations from elders in the church about such people deserving to be stoned to death according to scripture.

This was rather confusing and terrifying to hear from people who were supposedly worthy of my attention at a time when I was coming to grips with the fact that I felt attraction to both men and women.

To deride psychotherapy and casually offer "free church services" as an alternative in the same sentence is pretty humorous to a person who has had life changingly positive experience with therapy...therapy that arguably became necessary after years of indoctrination and instilled existential dread by those free church services.

I'm not railing against all churches, and there are some great organizations. But it seems only fair to point this out in an article that calls therapy to task for those instances when it doesn't work.

I, for one, am grateful for therapy. It saved my life (literally), and has been an incredibly positive force in my life.

Homosexuality is an interesting case. The DSM classified homosexuality as a disorder until 1973, when the APA board of trustees voted to remove it as a disorder.

Is that a scientific judgement or a cultural one?

I don’t deny the effectiveness of therapy - I know of great successes personally and anecdotally and I understand self-reported well-being is improved broadly. And yet it’s not quite science or medicine. There is no real understanding of purely materialist mechanism of how it works.

What do you mean, "it's not quite science or medicine"? Medicine isn't infallible; it gets big things wrong all the time, often for decades.

Medicine gets things wrong no doubt, it’s subject to various fads and foibles but the redefinition of a disorder because of a change in societal norms seems different.

I don’t see the AMA voting to declare something that is a disease is no longer a disease. (Although maybe I’m wrong — alcoholism and addiction are now a disease.)

One reason you don't see that is that that's not the AMA's function. The AMA is a lobbying group.

> the redefinition of a disorder because of a change in societal norms seems different

Different how?

Early accepted medical practices were often barbaric, and not effective.

When we learned more about the human body, we stopped doing those things.

Much can also be said about the many fields of science, and the giant shifts that were necessary as the fields matured.

The psychiatric classification of homosexuality is not relevant to the anecdote.

That said, scientific endeavors revise themselves when they learn that they are wrong, as was the case with the removal of homosexuality from the DSM.

The many fields of science and medicine went through periods of growth during which they’d be laughed off as “not scientific” or “not medicine” by today’s standards. The mind is a lot harder to measure. There are often answers in principle but not in practice. This gap doesn’t make the entire thing unscientific, but in need of more progress.

How would you classify drugs that are proven to work for a given issue, but for which we have a limited or non-existent understanding of the mechanism of effect? Are these not medicines?

> scientific endeavors revise themselves when they learn that they are wrong

Exactly. And scripture is notably not revised when it is found to be wrong. I ask, which worldview should you trust more based on this observation?

I felt that the article is written is a style typical of conspiratorial literature, i.e.: presenting lots and lots of evidence for a false or straw-man claim.

The true message of the article seems to be buried in the subtext. they mention the cost of therapy (to the individual and to society) and they mention churches too.

To me it reads like this: I don't want to pay for your expensive psychotherapy through my insurance. Go to church instead (where, depending on the church, we might also get a chance to fill your mind with our regressive version of christian values.)

> Exactly. And scripture is notably not revised when it is found to be wrong. I ask, which worldview should you trust more based on this observation?

Clearly the scientific one. I think we're in complete agreement here, and that's why I highlighted that part of the article. My point was that it seems laughable to raise issues with therapy while presenting church as an alternative.

The sentence you quoted was directed at the other commenter's seeming implication that homosexuality's removal from the DSM is somehow an indictment of the psychiatric discipline (maybe I'm misreading them, hoping I am).

> The sentence you quoted was directed at the other commenter's seeming implication that homosexuality's removal from the DSM is somehow an indictment of the psychiatric discipline

There must be some logical fallacy named for this. I've often seen this critique in terms of pandemic policy. ("Why should you believe what you're saying, when you've changed your mind before...")

I cannot disagree with the contents of this article enough. I can only go by my own personal experiences with psychotherapy, and observing family who have done the same, but the results speak for themselves. I was in a much worse place before psychotherapy, costing myself more in real dollars, time, and needless pain.

Psychotherapy is a tool, it's not a panacea, but ultimately if it safely helps people feel and live better then why throw so much shade ?

I was about to start psychotherapy last month, I ask my family's friend therapist If he could recommend me where to go. So he interviewed me for about 30 mins and ask me about all my problems.

A week later he send me the number of the therapist. I didnt write her yet, I think I dont need it as badly as before.

Those 30 mins were key. I am highly introspective and logical, I only needed to orderly speak my problems.

Go to therapy. It will be very effective due to you being introspective and logical. Your logical reasoning will be put to test by the therapist and what you thought was logical will be challenged constantly. This will illuminate your entire thinking. This is damn near impossible to do on your own. You would rather take a plane to travel a thousand miles than crawl there on your knees.

Thats a very interesting point. Maybe speaking my problems just "calmed" my anxiety temporarily and that why I thought I dont need therapy at the moment.

But yes, I will have to go eventually.

Yeesh this dude went to the Word Store on a $5 budget and put $300 on the in-store credit card.

Sounds like SOMEONE is pissed off he got dismissed from his psych professorship. So first he sounds like a white nationalist, now he sounds like a scientologist.

Seeing a shrink ruined my life. I used to be happy, productive, and socially engaged. Now I'm bouncing around medications, sleeping on the couch all day, and constantly ruminating about the past that I lost.

Feelings are less important than the big picture of your life. Fuck mental health care for convincing me to prioritize my feelings in the moment over my long term happiness.

First, I just don't get how after knowing about freud and his views anyone can trust freudian therapy. Second, I also don't get how people trust strangers with intimate details of their thought life.

I suppose if being happy and functional is your goal, it makes sense to do whatever you can to improve your chances. Personally, I prefer to experience reality and find truth even if it isn't happy or beneficial. I never hear them give advice that makes people unhappy or ask people to sacrifice for others. Furthermore, fundamental views and values I hold are likely very different from any therapist, so they can't qualify to advice me (and many others). Based on what I know about human nature, it's pretty damn scary how much people trust therapists.

Check out century of the self, a documentary I found on HN actually that documens how freudian psychology and modern marketing and capitalism aligned and worked together in the 20th century to create the world we are in today:

https://youtube.com/watch?v=eJ3RzGoQC4s

Is most therapy practiced today Freudian, in any sense more meaningful than that Freud helped inspire the whole field?

As I understand, he didn't merely inspire but architected modern psychoanalytic approaches. But even those aside, specific teachings of his or evolutions of his teachings are still thaught. Oedipus complex is the one I dislike the most, claiming boys want to murder their father and sleep with their mother at a subconscious level.

IMO, many cultures long before freud used religion and other means as part of mental health treatments.as I alluded earlier, I take objection to the approach he championed where psychoanalysis is done by people who don't consider belief and world view compatibility and goals that are wildly different from their own. How can you fix a problem for someone if you don't even know what the root cause for that person is and what they want the solution to be? This is a highly subjectivr field where reductivist (why they call them shrinks) approaches only work as a matter of statistical success, not correctness of the approach.

Again, just my opinion and observation.

In my experience, just understanding the mental world someone lives in is a huge undertaking. Two people can look at the same thing and have thing mean wildly different things.

The user you're responding to has no understanding of psychoanalysis, Freudian or otherwise. There is a long standing tradition of judging the field from incredulity at Freud's simiplified conclusions, and you never hear the real critiques of the field from anyone who disputes the way that user does. Better critique comes from seasoned psychoanalysts, e.g. Deleuze and Guattari, and is unfortunately often inaccessible to the public.

As the user he is responding to, your comment and pompous academic attitude is another cririque of mine. You know best and can't be bothered with specifics, because how dare anyone even question the field withour credentials.

"Second, I also don't get how people trust strangers with intimate details of their thought life."

Pretty simple: legal barriers to revealing that information creates an open space for discussing those thoughts that you don't feel comfortable revealing to friends or family.

That's what I don't get, you have such grear confidence in legal barriers but keep in mind, your therapist also has assistants/staff sometimes, they take notes that could get leaked/stolem, they could get hacked if it is digitally stored,etc...

I mean, some shit I wouldn't even dare speak out loud anywhere near a smartphone or network connected device. These days, you say the wrong thing and they'll put you in a 72hr psych hold and ruin your life (having to explain that to your work/spouse!).

Beyond that, these people are experts at manipulation (to an end they consider good), they could take that information and get you to think in a way that is undesirable to you.it could be life changing but it that change does not have to be positive. Your putting your faith in a lot if humans and a lot of processes and checks working right.

If you're concerned about those things, then I get it. I'm not - I've never had an issue.

Yeah, I mean whatever you find helpful, power to you.

Therapy is to our modern life as Confession once was to the past.

A key component of therapy is that it is judgment-free, unlike the harmful hatred that can be dealt by a pastor in Confession.

there is no judgement free context

[for depression] should be added in the title (I don't know about other psychological disorders, but this one is specifically discussed in the article.)

Obvious Scientology tripe, or the author thinks it's April 1st. Try taking a manic-depressive off lithium for a couple weeks, but only if they live with you.

There's a lot of dismissiveness here. What I don't see, so far, is even one comment actually engaging with the statistical analyses that are the heart of the article. (Maybe one's being written by someone else while I write this.)

I assume most people here are very skeptical about homeopathy. And yet, there are plenty of statistical studies that "show" that it works. The interesting thing about them is that the more rigorously the studies are done in terms of conforming to best practices for minimizing the risks of confounding errors, the smaller the statistical affects are, until they get to near zero for the most rigorous ones. Which is exactly what you'd expect to see if the effects of homeopathy are actually nonexistent other than placebo. Which I believe them to be, since the "theory" behind homeopathy makes no sense at all to me.

The article we're discussing here purports to show a similar thing: Studies that correct for more confounding factors show smaller effects. I can't judge how factually true analyses found in this article are; the writers may be making it all up. On the other hand, it could be a mistake to dismiss it out of hand just because its conclusions are not consistent with today's common wisdom. Also, we should note that anecdotal reports from individuals, here or elsewhere, about what good it has done them don't disprove the author's point. Psychotherapy can work for some people but still not have a great average effect size.

Personally, I'd be very surprised if psychotherapy is actually worthless on average, although I think that the therapy I had in my late teens and 20's, for years, probably did me more harm than good, other than just having a group therapy group to talk to. Which WAS valuable. But most of the good came just from talking to other people who happened to be in the group, not from the therapist. (I had individual and group therapies during that period. I think the individual therapy was probably worth less than nothing; there were definitely harmful things that came out of it that I am very clear on decades later.) But my personal story is just another anecdote. It seems logical that if someone is trained in helping, and someone wants to be helped, then on average there would be positive results.

But they may not be as much as is commonly thought to be the case in today's world.

What are some reputable "statistical studies" that show homeopathy working?

I read an article some time ago that analyzed this in depth, and was very specific about a number of studies. I can't pull them out of my memory now, but I found the article very convincing.

The ones that were less rigorous might be ones that you would count is "non-reputable". But they are considered reputable to people working in the field of homeopathy, who believe them, and the article included studies with control groups. But, for instance, studies that weren't double-blind, even if they had control groups, got more "results" showing that homeopathy "worked" than studies that didn't.

And note that you can't really have double-blind studies for psychotherapy.

The reason CBT is considered a gold standard in therapy is that it's supported by RCTs.

This reliance on an overwhelming amount of scholarship and citations is typical of conspiratorial writing, so it put's me off.

I definitely won't be engaging with this evidence, basically: I don't want to be sealioned.

From this logic, most serious scientific studies are typical of conspiratorial writing.

I mean outside of scientific circles of course, you are reading that point too literally.

millions of people benefit from psychotherapy every day, but random substack with predictable ties to right-wing nativist bullshit says it's all bunk. Well that's that then!

I know several people very well who have struggled immensely to get helpful therapy.

I myself have tried going down that route several times and come away disgusted by how bad it was. At best… at best it was emotional intelligence and self care at a grade school level. Talking to the provider was like talking to a robot or someone reading a script in a call center. The providers consistently effected a tone not unlike how one patronizes an unruly toddler. It was impossible, literally impossible to get them to switch to speaking to you like a person.

I have known several people who went into to psychology mostly to serve their own navel gazing. Have heard several explicitly say the opportunity of manipulation (yes using that word) excited them.

I’ve studied the history and present level of knowledge, the quality of the science backing it, and come away more concerned the more I know.

Folks generally need people to talk to about the difficulties of life.

The medical profession on that topic is… not that great. You don’t have to be a political whackjob to have serious concerns.

I know several people who have struggled immensely with getting routine medical care, not for lack of financial resources but because of how opaque and impersonal clinical health care can be. I'm not happy about that. But I don't extrapolate from there to the uselessness of medicine. If I get an infection, I'm going to go to a doctor, and not attempt to tough it out the way the Winegards suggest people with mental health ailments do.

> I have known several people who went into to psychology mostly to serve their own navel gazing.

Thats a lot better case then people studying psychology to become psychologists because they are trying to heal their own severe emotional and mental issues.

You're assuming the very thing in question.

https://en.wikipedia.org/wiki/Begging_the_question

Wrong, my fallacy of choice here is ad hominem.

I was not impressed, and this is before I knew who the authors were.

I think it's worth examining, but only to see how right-wing cranks cosplay as scholars.

1) They keep using passive voice, like "Scholars say..." to introduce their critiques. One could be bad writing but multiple times is suspicious. WHICH SCHOLARS??? This is a sure sign of someone trying to obscure the motives and origin of their critique. The white nationalist author identifies himself as an independent scholar, which suggests strongly he really means far-right cranks like themselves.

2) The authors never clearly identify their target. Who are they attacking - popular representations of psychotherapy, or the validity of psychotherapy itself? They introduce the topic with culture war tropes, gesturing vaguely to what elites talk about at "cocktail parties" (what is this, the late 1960s?) and incredibly, the movie "Ordinary People" (1980!).

Anyway, they assert that there is a myth in popular culture and then tear down the most simplistic version of the argument - that therapists are superhuman engineers of the soul. Strawmanning heavily here, and presenting a false dilemma - one can only be self-reliant or only depend on therapy.

But so what. Popular culture gets a lot of things wrong.

3) In any case, by a somewhat crooked road, they proceed from there to some critiques of the effectiveness of psychotherapy, itself. And it's worth considering. All of social and medical science is undergoing a huge replication crisis.

They rely heavily on meta-studies. Unfortunately, those studies show the opposite of what they are claiming. So by various techniques, they try to mathematically weaken the conclusions of those meta-studies, coming up with surprisingly precise numbers about how wrong the studies are. (This, by itself, is already a hallmark of the right-wing crank.)

Is psychotherapy just great all the time? No. I've had my share of therapists that I'd consider pretty awful. But anecdotally I've found that the more academically qualified, the better the therapist is, and the closer they adhere to evidence-based therapies. If the Winegards' critique was true that the field is rotten, it should be the opposite.

I can't help contrasting these author's arguments with a book I happen to be reading right now, The Body Keeps The Score, by Bessel van der Kolk. This is a best seller which may have done more than any other book to inject concepts like trauma into contemporary consciousness.

I'm just in the first chapters, where van der Kolk works in a VA hospital where there are many divots in the wall, due to Vietnam veterans flipping out and punching it, often over trivial frustrations. These are conservative and military people, and they have tried hard to do what the Winegards prescribe - going to church, not dwelling on their past experiences - and they fail, because their trauma keeps reasserting itself. van der Kolk later sees some of the same signs in his civilian patients, and as a young intern assigned to monitor patients on the late shift, hears many confessions of abuse that are never repeated to the doctor in the morning.

The Winegards attack the concept of psychotherapy as if it's quack medicine for trivial ills, the kind you can shrug off with a little grit. And their critique remains at a safe distance from the problem, through their own vague perceptions of pop culture and browsing the internet for meta-studies.

If the Winegards could show some examples of people overcoming trauma by just manning up, praying or, suppressing things and getting on with it, then maybe I'd be interested. Or if they wanted to talk about the eroding of medicalized terms through popularization, like "trauma", I'd be at least partially on board. But they don't, and they won't.

Like all right-wing cranks, they aren't concerned with what you might assume; that is, the health of patients. they're concerned with knocking down "elites". You know you're dealing with a right-wing crank when they characterize their enemy as an elite that is both contemptibly weak and inexplicably strong. They offer no explanation as to how their enemy's cultural power was achieved and maintained. It certainly couldn't have been because it kind of works or because the need is great. It's always because of the masses being hypnotized by messages in the media - like, you know, Ordinary People (1980).

Beware this sort of thinking, because it leads to reactionary solutions.

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