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Comment by mvieira38 | Hacker News Reader

Maybe off topic: I can't for the life of me figure out how therapy isn't a scam. CBT as proposed and studied in lab settings can't really be applied in the wild like most evidence based therapists try to, and the results of therapy I come across always seem extremely underwhelming. Maybe for some cases like severe phobias there is something to be solved, but do we really need to be paying thousands of dollars a year for a therapist to say "hey, maybe if you'd invest more in hobbies, social relationships and a healthy lifestyle you would feel better"?

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It generally is. People like being heard. But usually they sort themselves out during the first therapy. If that fails usually more therapy doesn’t solve anything either.

As somebody who studies psychology.. If a psychological study says A, it’s more likely to be actually B. The quality of research is much, much worse than people think.

>"hey, maybe if you'd invest more in hobbies, social relationships and a healthy lifestyle you would feel better"

"Just saying" the above is not what CBT is, though. I've had a lot of CBT and other kinds of therapy, and I've never had a therapist just tell me "so don't do that", or "do more x".

It's about analysing your own thinking(cognitive) and actions/habits(behavioral) in cases where those are keeping you stuck in a miserable situation, and identifying what you can do to change them.

Sure, if you put the most inanely over-abstracted construction on it like "just live healthier and you'll feel better", it sounds meaningless, but the implicit assumption there is that's something you can just decide to do, and succeed in. That's not the case for many people, and those people can benefit from CBT.

i used to be quite pessimistic in my thinking without ever having a realisation of that thought process but as i got older i realised i am pretty miserable and CBT in a way helped me change that thought process and my overall thinking. therapy didn’t really work for me but CBT certainly did.

You can only get out of therapy what you put into it, so if there only problems you are bringing to your therapist are a need for investment in hobbies, social relationships, and a healthy lifestyle, then that's all you're gonna get. Now, it's entirely possible that really is all you need, but for those stuck in traumatic response loops due to eg PTSD from respressed memories of childhood, leading to, say, a string of failed relationships with toxic people who don't respect your boundaries because you didn't have a good model for them growing up, therapy can be quite useful for helping people heal from generational trauma and break the cycle. It sounds cliché to blame it all on bad reaction to things that happened in childhood, but, well, we did all have one (unless you didn't; early parentification is an acknowledged failure mode), and even if the worst was emotional stunted parents (as documented by the book Adult Children of Emotionally Immature Parents), childhood that was totally fine on the surface may not have been.

Again, of course, if you are a well adjusted adult, and no one in you life is clamoring for you to get therapy, then chances are, either you've pushed anyone and everyone away that cares for you that deeply, or you don't need it, both of which are totally possible.

As for if it's a scam? That word gets thrown around too easily these days. Do they cost a lot? Yes. Are you worth it? Also yes. That's not to say all therapist are equal, and someone that's great for you might be terrible for the next person, and some of them are just bad. (There are also those that are quite good!) As there are with all things. Going into therapy with specific goals on things you want to work on (eg irrational anger at some specific thing that's ruining your life) tends to help it not be just an ongoing extra expense like a gym membership, if that's not what you want. At the end of the day, they're stuck in the system as much as you are, and paying them also makes it feel more balanced in that they're being paid listen to you go on and on and help you with your ish. You wouldn't/shouldn't treat your friends so one-sidedly. That said, it's entirely possible to pay to see a therapist and not get anything out of it. I will admit to that as a possible failure mode, but it's a failure mode and there are certainly success stories out there of people turning their life around and becoming happy well-adjusted adults.

> CBT as proposed and studied in lab settings can't really be applied in the wild like most evidence based therapists try to,

Because that part is wrong, apart from the underlying inner working being dissected in labs (the cognitive science part), the therapy part it is well studied in the wild - and it works.

> and the results of therapy I come across always seem extremely underwhelming.

So you mean anecdotes? Of course you recognize the underwhelming results - the people where it worked well are less noticable, by definition.

> Maybe for some cases like severe phobias there is something to be solved, but do we really need to be paying thousands of dollars a year

That you have to pay money has been a decision of the society you reside in. It doesn't have to be this way, and in fact it isn't in most industrialized countries.

> for a therapist to say "hey, maybe if you'd invest more in hobbies, social relationships and a healthy lifestyle you would feel better"?

That is a strawman, not CBT.

I think therapy can be used very strategically. Maybe you want to end a friendship and don't know how to break it to them. Or maybe you don't like the way you are being treated by someone and you want to know effective ways of setting boundaries. Therapy can be super useful in giving you the tools to confront difficult emotional/psychological situations.

We managed to turn the internet into a massive addiction machine and are currently tackling a propaganda-fueled epistemic crisis that has reached the very top levels of politics.

So somewhere there is evidently a lot of knowledge about effective, working psychology, even if that knowledge is used for evil rather than good...

Eh, therapy can vary widely in quality.

And peoples lives can also vary in quality. If you're raised in a nest of narcissists it is likely you'll have a very skewed view on relationships and your idea of normal could be considerably different from the average and have negative effects on your social relationships. Sometimes you just need a 3rd party to tell you that's not normal.

Coming from a family of narcissists myself they quite adamantly stuck to the idea that therapy was a total scam. Though my observing their behaviors it is my believe they are really saying "Therapy is a total scam because they didn't tell me what I wanted to hear".

What’s the practical difference wrt. psychology (whether it can solve it) between the problem of not being able to get over a phobia and the problem of not being able to apply rationally simple life advice? Why is the former “something to be solved” but the latter one is not?

There isn’t a clear line, that’s what makes it tricky. Think of it like troubleshooting a very advanced robot that’s misbehaving or underperforming. The first question that gets asked is “hardware problem, software problem…?” And the answer is ‘neither, and both, it’s complicated’. Usually the problem is a feedback loop between mechanical, hydraulic, electrical, software, environment… If your robot is overheating, is it design (undersized radiator), mechanical (insufficient coolant flow/airflow), software (wrong current limits, temperature setpoints, no thermal throttling), configuration (inefficient design of routines), usage (duty cycle too high), or environment (too hot)?

It definitely is but conveniently you can't prove it and they can't prove otherwise.

Most of the social "science" are a scam, but since it gives peoples some "work" it keeps going. In reality it's only value extraction and they are basically parasites of the common people but since the people in that field have a lot of power ("educated", often female, etc) it keeps going. It's like the HR department; you would rather not have them but since there are laws around it you pay the racket and move on, not other way.

I think therapy is at its best when it's a rubber duck and debugger for changes you are already trying to make. It doesn't solve anything for you.

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