My takeaways from 12 months of therapy
cauldron.life
cauldron.life
It’s easy for the layman to misunderstand how these different types work in practice and for what circumstances they’re well suited.
I once underwent psychodynamic psychotherapy for a serious interpersonal relationship problem that was taking a devastating toll on my life. When I had reached a point where I was ready to discuss what (if any) therapy came next, I thought CBT (cognitive behavioral therapy) would be right for me after reviewing the particulars.
It’s important to note that along with different therapies, psychologists are also quite different. There are different schools and concepts that a psychologist may subscribe to or favor, and of course each has their own personal approach and style.
It turned out that on paper I thought CBT would be a good next step, but when I got there with a therapist who specialized in it, it wasn’t what I needed or wanted, and while I liked the therapist, I didn’t much care for their style of rapport building.
Anyway, I agree when they say that people who need therapy the most are the ones who cannot afford it. It makes you think different, not just pat you on the head and commiserate.
I agree with you, I'm pretty sure after that there are things that were explored and not explored that maybe are hidden from view.
A good friend of mine is very good exploring things with "why is that?" or "give me an example" but they are just tools.
So now whenever I am in a tricky situtation, I ask myself that question. It gives me more understanding of my feeling.
And once I've more grasp on it, I can tackle it better.
Though I was not sure about sharing them and more importantly I still have to clearly identify them and list them out to be able to share.
It would be a good exercise and I will try to do that. Thanks for the idea.
On the other hand this is where therapy starts and ends. Ultimately a therapy is started because the answer to it is too negative. And if it's positive enough afterwards, it means the therapy was successful.
Or to put it the other way, there are issues where a Psychological tag can be put upon. After all the classification is largely a statistical one. But no therapy may be needed when the person is doing well.
Obviously things are more complex but from someone seeking Psychotherapy this is what it boils down to. Granted, some problems cannot be solved by Psychotherapy but that's a different topic.
Also I think it's worth mentioning that many people cannot even answer this simple question. No expert on this, but my presumption is also that through expectations e.g. in society and the career objective points are more in focus and not so much how an individual feels about it.
Really all you can do is stick with it for a few months and see if you get better. It’s hard to tell in an immediate moment if it’s good
You can tell they've never dealt with a person with narcissistic / sociopathic personality disorder. You express your emotions to them, all it does is provide them with a crystal clear signal of how to push your red buttons and believe me they will.
A lot of therapy is based on the assumption that "we're all the same" or "we all mean well" but it's simply not true. There's real scum out there.
Many people actively work on making other people's lives miserable, everyday.
The solution to this, by the way, is not to become more sociopathic but just to be aware they exist and how they operate. The kind of schemes they put together are embarrassingly simple to understand and spot, but only once you know about them.
I always thought that coursework/lectures on this topic during high school would be extremely beneficial for the young and perhaps even quite fun to go through.
Yup, and that's a particularly important lesson in context of group dynamics, where a large enough group (of say 10+ people) almost certainly contains some bad eggs, and if you present yourself as either isolated or psychologically vulnerable, these people WILL single you out.
Though the corollary is true as well - if you meet enough people, sometimes you will get to find folks who surpass your expectaions.
In a way, it's like talking about friendships. Some people certainly have better "friendship skills" than others, but because a given person has such skills, it doesn't automatically make them a good friend to everybody.
Can you say any more about how a therapist might be more suitable for some patients than others? Is it about a methodology (like cognitive behavioral therapy), or about disorder(s) the therapist usually treats (like addiction), or is it something else (possibly something the patient won't discover until after treatment starts)?
If it’s all about methodology then a) we’re robots and b) there would be no need for therapists.
The 1st one asked me the most basic nonsense and then told me she thinks I just drink too much coffee so I didn't go back.
The second one told me they don't believe in medication so I never went back.
The 3rd one diagnosed me with seasonal affective disorder in about 5 minutes, gave me a little prozac and changed my life.
I suspect there is an overwhelming amount of terrible therapist.
I don't think the challenge is finding a good therapist but in not getting stuck with a terrible therapist or letting a terrible therapist ruin the whole idea of therapy.
Imagine if any other doctor operated like that like you had to visit 3-5 endocrinologists to get a diagnosis for your thyroid disorder.
And even if you find the right guy/gal, the best they'll probably be able to do is help you help yourself, as most of the problems in ones life have external causes, and it falls to the individual to resolve them.
It's just baffling that this is considered a legitimate medical discipline in 2025.
Even though self-help is considered a meme, I found way more success with it, as flipping though 5 different books until you find the one that you like and is much easier than visiting 5 therapists. And being honest with yourself is also much easier than being honest with a complete stranger.
Most mental issues have internal or behavioral causes. Therapy addresses your ideas about the real world, not the real world itself. For example, it can enable a choice never seen as possible before, and while the real world stays the same, your position in it may change to something unthinkable before.
That way of thinking treats therapy almost like medicine.
Sure, lots of self-reported successes by patients with no control to compare against, but at this point there is just as much self-reported evidence that prayer works.
For medical treatments, the bar should be higher than "patient believes it worked".
i imagine success stories tend to self-select as well. if you go to therapy in the first place it means you're admitting a need and willingness to change.
if a person thinks they know everything and can't benefit from therapy then they're probably unlikely to gain anything from the experience.
But this is true of things that we already know don't work - aromatherapy, homeopathy, acupuncture.
The evidence for therapy is neither more nor less than the "evidence" for things we already know fails double-blind studies.
"The effect's associated prediction interval −0.05 to 0.50 suggested CBT will remain effective in conditions for which we do not currently have available evidence. While there remain some gaps in the completeness of the evidence base, we need to recognise the consistent evidence for the general benefit which CBT offers." https://pmc.ncbi.nlm.nih.gov/articles/PMC7856415/
"Eleven studies compared response rates between CBT and other treatments or control conditions. CBT showed higher response rates than the comparison conditions in 7 of these reviews and only one review reported that CBT had lower response rates than comparison treatments. In general, the evidence-base of CBT is very strong. However, additional research is needed to examine the efficacy of CBT for randomized-controlled studies." https://pmc.ncbi.nlm.nih.gov/articles/PMC3584580/
To give a very "Hacker-Newish" snappy remark:
So, if the therapy teaches you programming, and you thus get a much better job improving your life, you'd claim that "learn to program" is a suitable therapy? ;-)
Learning to program isn't therapy. Learning how to learn to program might be.
Then learning to program is therapy. :-D
I am serious: Learning (very abstract) mathematics, and programming, taught me an insane amount about myself:
- how I attempt to model and structure the world
- how better models of very diverse phenomena look like
- what such insights mean for my life
- ...
> Then learning to program is therapy.
Are you trying to say that learning to program is not learning logic?
It’s not like with a broken bone where you can look at an image of the bone and see that it has healed, you have to rely on what a person tells you, which is inherently subjective, and since a person can’t be cloned, you can’t have a “control” either.
OTOH what happens if there is a whole species of beings who are smarter, stronger, … than our species? Would our collective purpose become to accept them as our betterment? Our personal purpose would vary greatly from fear to wonderment.
Yes. With two different therapists. Also people close to me have been.
I see no difference between the results from therapy and the results from prayer and a belief that aliens with UFOs made things better.
It’s tiring honestly, you are not allowed to criticize therapy in the current year.
always
That should mean something. But I agree that people may omit important details about the structure of their therapy work, so it may not feel convincing. To make sense of what I mean by therapy, look at my recent comment history. It does not boil down to the “emotionally right” one. I’m quite different from and not really emotionally connected to mine, for example, although I respect his professional skills very much.
It's a bit unfortunate that people out of the psychology area don't even really know that there are multiple different Psychotherapies approaches and that they vary wildly in how problems are tackled/studied (source: my wife works in the area).
You'll not be able to prove validity of the concepts behind this school of therapy themselves in any other sense, even if you would be able to identify some coherent set of concepts from all the various techniques and approaches that CBT subsumed over the years.
And certainly just because "if you follow these practices, you will maybe get better" metric does not say anything about validity of the concepts of a particular school of therapy in any case, no matter what school you're talking about.
I mean yeah, many people usually care about whether some therapy works and how well, and not whether the concepts that you're told in therapy to justify what the therapy is doing make coherent sense or can be scientifically validated, so this is usually not a problem for people in need of care. But idea that CBT's concepts are more objective than other mumbo jumbo therapies out there is just plain wrong.
Idk if my therapist used something from outside of CBT, but he definitely marketed himself as a CBT-ist. I was never given this "these practices" thing. I've solved my:
- Environment control anxiety (long story)
- Strong anxiety of being late. Eradicated via specific methods that I fully understand and were specific to me: recollecting the actual source event through pre-sleep questioning, realization of specific anxiety behavior loops (just by talking about my routines) - long preparation and inability to do anything deep 4-5 hours before an appoinment, then few times intentional being late, then later unintentional, now I mostly don't care when it's not a big deal and not my need. Can just do my things up until a notification, or miss it completely.
- Depression with one heavy clinical episode without using pills. Basically I have found a key misconception in my life, work related, and adjusted thoughts radically to a real reality rather than old made-up (which was so comfortable to people I worked with).
Is that mumbo jumbo? Cause if it is, I couldn't care less how anyone calls it. That said, I can see how different people could fail to perform the methods and ideas involved. It really requires a skill of debugging and questioning yourself. Lots of people are too stubborn to even think about being less stubborn for just a minute, ime.
Therapy school can have simplistic invalid theories of functioning of human beings, and still be useful to some people. Just like religion can be psychlogically useful to people but it's all nonsense. Whether some therapy works says nothing about rationales and theories behind it, in other words.
Whether you got better or not is irrelevant to the question of whether CBT views on how human beings function are valid.
1) It still involved structured work without which it couldn’t sort out on itself. Okay, this is still religious. I believed (wanted) that it should work, and it did. But we’re talking about modifying thinking itself here, beliefs themselves. That’s a strange area because how can you even avoid that? It’s sort of an incompleteness theorem thing. Like, a therapist changed me, but he can’t change those who don’t believe in change, while “belief” is a part of the… yadda yadda. Iow, how does one falsify a therapy, I guess?
2) Since we’re talking statistics and not structure (are we?), can it be that naturally only a part of population can be “cured”? Like, you can’t cure really bad medical cases either, and some of these are common. What if there’s a consistent set of prerequisites and “therapothropism” is not random? I guess this question is naive and there’s more to it, but can’t think of anything here.
3) In my experience, religion is much more shallow wrt to “you”, and is fixed. In a sense that cbt solutions are more “meta” and then get tailored to the personal events. While religion is usually an omnidude watching you and many others and rules and requirements are all the same. CBT actively refrains from judging and giving specific advices. Even from both-religious position, is it fair to put both on the same line?
What tools for "measurement of success" does a psychiatrist have that aren't available to a therapist?
When you go to a psychiatrist, now we are talking medical treatments. That is where you get a specific diagnosis and possibly medicine to change how your body and mind work. That is where to expect objective results.
Both explore what is needed by talking to patients, often with some testing... but they are not the same thing. And neither are going to solve all problems for all people. But it helps to evaluate them properly if you understand what they are, and what they are not.
Most kinds of therapy, by contrast, are closer in their empirically measured effectiveness to studying geography through astral travel or studying history through past-life regressions. CBT and exposure therapy are among the few exceptions.
If you remove the assumption that a deity answers the prayer; what they're doing is focusing on gratitude and if asking for things they are identifying goals. This is a healthy mindset so unsurprising that they report it "working".
If the patient is happier, does it matter if there isn't an objective measure.
There is an extremely large body of evidence that therapy substantially improves psychological disorders as measured by these diagnostics and measurements.
What are you talking about?
Quite to the contrary, while there is plenty of evidence of specific types of therapy yielding actual results, there's often very little evidence of the methods commonly applied by psychiatrists (i.e. medication) to be actually beneficial.
In fact, some types of psychiatric drugs (with SSRIs probably being the worst offender) are actively harmful, while evidence of their presumed positive effects is vague and ambiguous at best.
The take away is basically you should pay attention to your emotions, don't be afraid to express your emotions and don't be afraid to try new things. Which feels like something you would see on instagram written over a sunset.
Perhaps its just a case of the difference between knowing the path and walking the path, and the 12 months was learning to walk it.
Therapy isn't really about the advice but actually transforming it into action, as you say, walking the path instead of just knowing the path.
But for someone who is, let's say, suffering from depression, the aforementioned path sounds like cheesy bullshit and not a source of happiness at all. They don't do those things for many different reasons depending on the person's psychological history, and the advice sounds empty because they don't realise it actually works.
I had been avoiding that advice, pretending outwardly that it was bullshit, for 30 years of my life. Those cliche Instagram slogans actually do mean a lot to me now, it just turns out I literally spent my entire life until now unconsciously, but actively, avoiding them.
The way I learnt to take my first step on that path was to understand the rich psychological tapestry that caused me to avoid the path.
1. Older adults are less open. I wouldn't just start texting someone from work about my favorite bands after knowing them for a couple weeks. In college that was common.
2. Children and family responsibilities are primary relationships, while in college friends are primary relationships.
3. Energy levels drop and responsibility rises as you age; limiting what you want to do.
4. There is a light social pressure to "act your age" that has a small governing influence to adult relationships.
I have good friendships, but almost all of my adult friendships are from college and highschool. Hanging out is usually a set activity like hopping on a game, grabbing lunch, or maybe biking, golf, etc on a sunday. Work is where I meet people and all of those relationships tend to be tainted by the professional relationship.
How did we evolve to need a professional objective therapy instead of strong support systems.
Evolution works on the scale of millennia, we've been the same organism for the past 300k years and it's random best effort that only selects based on what kills you before you procreate, it doesn't guarantee anything at all.
Professional therapy (at least the one I experienced) uses well-defined methods in addition to drawing parallels and analogies. Downward arrow, event/emotion logging, exposure, core belief removal methods, etc. I was really intrigued when I realized that therapy is not about whining and listening to "it's okay" or shallow advices, but akin to debugging and programming with a mentor who already seen most bug like yours and only needs you to start dumping logs to confirm.
You can come up with something vaguely like this by accident, after talking to lots of friends. But why bother if you have a professional who can point out the inconsistency and suggest/explain the way to solve it in just in a few sessions?