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In the UK there is a separate profession (and qualifications) of psychotherapists. They don't necessarily have a qualification in psychology or psychiatry, or w

In the UK there is a separate profession (and qualifications) of psychotherapists. They don't necessarily have a qualification in psychology or psychiatry, or work as a social worker. I thought this was true also in the US?. (Anyone can call themselves a counselor in the UK. Not sure what qualification clinical social workers have). My second point was simply that pragmatically, an hour or less per week, which is how much time you see any of these practitioners, is not all that much time, and during an actual session they have to deliver the therapy. Most decent practitioners will spend some of their time outside actual sessions thinking about their patients, and human nature is that they will probably think most about the newer ones. Unless your therapy needs no serious 'course corrections' after the first few months, it is probably easier to find a new therapist than to get an existing one to rethink. As I said, this is based on my anecdotal (but unfortunately very long) experience; take it how you will.

thelettere 11y ago
In the US the regulations differ, and depend on the discipline (i.e. it is not unusual for a therapist to meet qualifications for one state, but move to another and no longer be able to practice without further education or testing). There is no actual "psychotherapy" discipline so named - just the collection of ones I mention above. However, in the vast majority of states the terms counselor or psychotherapist or psychologist or any number of related terms are protected by law for those who are licensed by a psychotherapeutic discipline alone. The only popular categorization of those who perform psychotherapy-like services here that anyone can use is "coaching" - but that's sort of therapy for well people looking to reach for the stars - they are barred from treating people with serious disturbances. On your second point, I find that an interesting idea. I do wonder though what the correlation is between the amount of time a therapist spends thinking about a particular client and their case and that case outcome. The research I've seen indicates that generally a good therapist (one whose clients achieve consistently better than average outcomes) does so regardless of the number of clients he has, or how disturbed his clients are. Out of curiosity, have you gravitated towards a particular type of therapy (CBT, psychodynamic, existential, ect)? Not because the treatment type matters a great deal, but its been shown that certain personality types tend to congregate in different theoretical orientations. Random thought that just popped in my head - I wonder whether one of the reasons why CBT is getting less effective is because it has attracted many therapists who feel pressured to do it because of its public relations successes rather than any deep affinity with its principles.
- DanBC 11y ago
  > I wonder whether one of the reasons why CBT is getting less effective No it's probably about better placebo controls. Pain meds in US: https://news.ycombinator.com/item?id=10351230 https://news.ycombinator.com/item?id=10351230 Anti depressant meds: http://onlinelibrary.wiley.com/doi/10.1002/wps.20241/abstract http://onlinelibrary.wiley.com/doi/10.1002/wps.20241/abstrac... Better response to placebo is not a new thing, and is not limited to psychological therapies. (These are all the same source, but lots of discussion.) https://news.ycombinator.com/item?id=783912 https://news.ycombinator.com/item?id=783912 https://news.ycombinator.com/item?id=1032149 https://news.ycombinator.com/item?id=1032149 https://news.ycombinator.com/item?id=3015479 https://news.ycombinator.com/item?id=3015479
  - thelettere 11y ago
    Yes but some placebos work better than others. Why is that? If only there were some source we could look to in order to find this out...
  - thelettere 11y ago
    To be a bit more explicit - the finding of that study was not that efficacy had gone down relative to placebos, but rather that the absolute efficacy of CBT is going down. The authors of the study actually suggest that the reason its becoming less effective is because of the opposite of your suggestion - it's going down because the placebo response is likely getting weaker in CBT (1). Which goes back to my original point about the factors that influence of efficacy of placebos - and of course, to the parent article. I think this would have been a much more productive conversation if you had just read it first before replying. (1) https://uit.no/Content/418448/The%20effect%20of%20CBT%20is%20falling.pdf https://uit.no/Content/418448/The%20effect%20of%20CBT%20is%2...

thelettere 11y ago

In the US the regulations differ, and depend on the discipline (i.e. it is not unusual for a therapist to meet qualifications for one state, but move to another and no longer be able to practice without further education or testing). There is no actual "psychotherapy" discipline so named - just the collection of ones I mention above. However, in the vast majority of states the terms counselor or psychotherapist or psychologist or any number of related terms are protected by law for those who are licensed by a psychotherapeutic discipline alone. The only popular categorization of those who perform psychotherapy-like services here that anyone can use is "coaching" - but that's sort of therapy for well people looking to reach for the stars - they are barred from treating people with serious disturbances. On your second point, I find that an interesting idea. I do wonder though what the correlation is between the amount of time a therapist spends thinking about a particular client and their case and that case outcome. The research I've seen indicates that generally a good therapist (one whose clients achieve consistently better than average outcomes) does so regardless of the number of clients he has, or how disturbed his clients are. Out of curiosity, have you gravitated towards a particular type of therapy (CBT, psychodynamic, existential, ect)? Not because the treatment type matters a great deal, but its been shown that certain personality types tend to congregate in different theoretical orientations. Random thought that just popped in my head - I wonder whether one of the reasons why CBT is getting less effective is because it has attracted many therapists who feel pressured to do it because of its public relations successes rather than any deep affinity with its principles.

DanBC 11y ago
> I wonder whether one of the reasons why CBT is getting less effective No it's probably about better placebo controls. Pain meds in US: https://news.ycombinator.com/item?id=10351230 https://news.ycombinator.com/item?id=10351230 Anti depressant meds: http://onlinelibrary.wiley.com/doi/10.1002/wps.20241/abstract http://onlinelibrary.wiley.com/doi/10.1002/wps.20241/abstrac... Better response to placebo is not a new thing, and is not limited to psychological therapies. (These are all the same source, but lots of discussion.) https://news.ycombinator.com/item?id=783912 https://news.ycombinator.com/item?id=783912 https://news.ycombinator.com/item?id=1032149 https://news.ycombinator.com/item?id=1032149 https://news.ycombinator.com/item?id=3015479 https://news.ycombinator.com/item?id=3015479
- thelettere 11y ago
  Yes but some placebos work better than others. Why is that? If only there were some source we could look to in order to find this out...
- thelettere 11y ago
  To be a bit more explicit - the finding of that study was not that efficacy had gone down relative to placebos, but rather that the absolute efficacy of CBT is going down. The authors of the study actually suggest that the reason its becoming less effective is because of the opposite of your suggestion - it's going down because the placebo response is likely getting weaker in CBT (1). Which goes back to my original point about the factors that influence of efficacy of placebos - and of course, to the parent article. I think this would have been a much more productive conversation if you had just read it first before replying. (1) https://uit.no/Content/418448/The%20effect%20of%20CBT%20is%20falling.pdf https://uit.no/Content/418448/The%20effect%20of%20CBT%20is%2...