8 ms·

Therapy Experience Associated with Negative Changes in Personality

82 points by whitepoplar 10y ago

curuinor 10y ago
Causal statement in the headline. You might think only correlational statement on paper, and this is somewhat true but it is a controlled ecologicalish study. no random assignment. bad temporal proximity of data gathering on personality. methodological poking about at the badness of controlled vs observational studies. basically study recruitment as a selection effect.
- maxander 10y ago
  They do perform a statistical analysis ("propensity score matching") to try to control for off-target correlations, but its true that the entire strength of the paper revolves around this having been done correctly and it being sufficient. Given the fact that improperly controlling for confounding factors could entirely account for their data (people whose personality traits are deteriorating are likely to have some awareness of this, and therefore to seek therapy) you would think that an account of this procedure would be front-in-center of their argument- but no, all details of that step are relegated to supplemental data for some reason. It's also worth noting that data collection was entirely done through surveys; so, another explanation could be that therapy simply made people more aware of pre-existing personality deficits, that they were then able to more accurately report. And further, even if the results are valid, it doesn't invalidate the benefits of therapy; most therapy methods are built around helping the patient. Its possible that therapy improves the subjective quality of the patient's life at the expense of some external qualities (or pretense thereof.)
  - civilian 10y ago
    > Its possible that therapy improves the subjective quality of the patient's life at the expense of some external qualities (or pretense thereof.) That's not the case-- they were measuring for subjective quality, and it was subjective quality that declined. I posted the PDF of the paper in my top-level comment, but the Psychological measurements they were looking at in the German cohort were self-esteem, life satisfaction, and depression. The US cohort was measured for self-esteem, chronic stressors, and depression.
- sctb 10y ago
  Thanks, we've updated the headline from “On average, psychotherapy brings about undesirable changes in personality”.
  - KingMob 10y ago
    Huh? I don't have access to the full article; is it about therapy in general or psychotherapy in particular?
- ouid 10y ago
  not to mention that an equally explanatory representation of the data is: "Pathological behavior is correlated with worsening pathological behavior"
  - curuinor 10y ago
    Not as explanatory. There would have been no difference from the ecological control then
benevol 10y ago
On a related note, educate yourself fully about LSD. Then make your fully educated decision on whether to go ahead or not.
- Kenji 10y ago
  One is never fully educated until after the fact ;)
  - klibertp 10y ago
    That might have been the point.
- metaphorm 10y ago
  related to your related note (which should have been less coy, and perhaps more informative): Those interested might be well advised to read their history and learn about the work that Stan Grof and Walter Pahnke were doing before the drug war crackdown.
coffeemug 10y ago
That doesn't surprise me. Anecdotally, everyone I know who is on a "self-discovery" quest never seems to discover anything or actually get happier. They tend to stay miserable and keep looking indefinitely. The people I know who do improve tend to stop looking and start doing (exercise, learning new things, etc.).
- dwringer 10y ago
  I like how you contradicted the main point of your second sentence in the third sentence.
  - andai 10y ago
    I imagine by self-discovery OP meant "thinking about / deciding what to do", rather than actually doing things.
- _yosefk 10y ago
  It could be that people telling others about such quests seem to fail in those quests. Not sure most people seeking therapy for issues greatly bothering them are going to tell you.
- SubiculumCode 10y ago
  Neither am I. Ruminating on how we are deficient is no path to happiness or balance. Exercise, eat right, volunteer to serve others who are down and out, learn something new, work toward a purpose or goal, and if necessary, get pharmaceutical help, because for some no lifestyle or conduct can help enough.
  - DanBC 10y ago
    The entire point of modern evidence based therapy is to help stop people ruminating on how they feel deficient.
    - SubiculumCode 10y ago
temp246810 10y ago
It's a shame that stuff like this makes it to the top of HN. Not because the content itself is good or bad, but because it is precisely someone struggling with this stuff who has a high likelihood of walking away from the article with the wrong message. I understand that we're all responsible for our decisions etc., but this is really out of our wheel house and hopefully the people in need of therapy consult with professionals before acting on anything that bubbles up here.
- benevol 10y ago
  > hopefully the people in need of therapy consult with professionals If your health care system gives you the option, that is.
  - epmaybe 10y ago
    What do you mean?
    - Nomentatus 10y ago
      Refusal. I've heard of that happening with the original "Catch-22"!
    - _null 10y ago
      A lot of people simply don't have access to psychotherapy. Many national healthcare systems and health insurers have very limited provision. Many people in the US are uninsured or have very limited access to insurance-funded psychotherapy, despite the MHPAEA and the ACA. Here in the UK, someone diagnosed with depression or anxiety by their primary care physician is likely to receive no more than six sessions of CBT, often after a wait of many months. Private psychotherapy costs £60-£100 per session, which is totally unaffordable for many people. We have a chronic shortage of psychiatric inpatient beds and very poor follow-up care. People who are hospitalised after a suicide attempt are often discharged the same day with little more than a prescription for antidepressants and the promise of a home visit by a community nurse. Sadly, the UK isn't an outlier.
zellyn 10y ago
Can someone with more insight in this field tell me whether this is the same as claiming that people who have heart surgery tend to suffer more subsequent declines in cardiac health compared to those who never needed heart surgery?
- Mizza 10y ago
  It might be more apt to say something like those who opted for an elective colonic irrigation ended up with higher rates of impacted bowels.
cavanasm 10y ago
Is there a non-paywalled version of this? The abstract seems painfully vague to me, or is there some domain specific explanation for desirable vs undesirable personality traits? Are they literally saying that therapy makes whatever people are in therapy for worse?
- DashRattlesnake 10y ago
  Have you tried Sci-Hub? https://en.wikipedia.org/wiki/Sci-Hub https://en.wikipedia.org/wiki/Sci-Hub
- deleted 10y ago
  [deleted]
taurath 10y ago
So say you successfully make a change to one or more personality traits - I'd expect self esteem to go down, stress to go up and all the negativity experienced to happen. Changing personality isn't like putting on prescription lenses, it's like changing from green to red glasses. Things can become harder for a long time after a perspective change - most studies I've seen on CBT for example show it's still good for longer term outcomes.
shirleman 10y ago
Are they implying correlation or causation? It seems like you would need a control group with a psychological issue that doesn't do psychotherapy compared to one who does. If someone is in psychotherapy, presumably, they could be in a deteriorating mental state. It's like saying a cancer patient that does chemo feels worse. That's how cancer works. An assumption of steady-state psychology of a person just doesn't make sense to me. Not gonna pay $40 to read and see if I'm right tho...
programminggeek 10y ago
Focusing inward on problems and negativity is a great way to increase the feelings of negativity and hopelessness. Instead, ignoring the how and why of a crap situation and simply working to improve your situation will improve your outlook on it. Do stuff to make life better and you will feel better as if by magic. Just ignore the problems until they manage to disappear on their own. One step in front of the other. 1 > 0.
- Nomentatus 10y ago
  I do believe there's research on PTSD showing this, if you could find it you might reverse being voted down. But there's evidence in favor of the opposite of the action you propose - people who see their problems and reversals as external and don't bother too much about them are much less prone to depression, according to the data. That doesn't mean they are successful or nice, of course.
- DanBC 10y ago
  > Focusing inward on problems and negativity is a great way to increase the feelings of negativity and hopelessness. Repeating an earlier comment: the entire point of modern evidence based therapies is to help people avoid focusing inward on problems and negativity.
- pekk 10y ago
  People with real problems like major clinical depression, severe anxiety that prevents them from leaving the house, schizophrenia, etc. aren't going to be suddenly cured now that you have told them "1 > 0" and all they have to do is put "one step in front of the other." "Just ignore the problems" doesn't work for people who have problems which are, you know, actually serious.
rrggrr 10y ago
People alone with their negative thoughts do real damage to themselves and others. Therapy is the only and/or and appropriate resource for many of those people. Negative attributes from therapy? Without a doubt it says more about the modalities, and even the therapists than the patients.
- drzaiusapelord 10y ago
  Not to mention, from my own perspective as a therapy goer, a lot of personal and mental problems stem from a certain lack of social skills or immaturity, as well as working through trauma or biological mental illness (I have all three). Yes, you might come back from therapy a lot more assertive and "mean" than you were before, but its important to note you were maddeningly depressive and a zombie-like 'yes man/woman' before. This reminds me a bit of the movie Awakenings, where one of the patients who came out of his coma was upsetting his mother. His mother was so used to him being this passive and lovable manchild that she couldn't handle him when he became assertive, spoke back to her, and wanted to spend time with young ladies and not with his mother. She never saw him go through a proper teenage rebellion stage and he wanted to live life immediately and really had no time for mother anymore because he just wanted to pursue his crush. To his mother, the therapy was a failure because she was no longer happy with him. I also think there's an element of becoming jaded as one gets older, generally. The more experience you have with people, life, etc the more you realize we really are not good creatures and a lot of the wonderful optimism we've been taught be in a spiritual, social, or familial environment are often wrong, if not entirely false and people are just simply predictable animals fighting for resources. Therapy and other methods of self-discovery often lead to these self-discoveries and can really lead to a certain level of 'depressive realism.' I read somewhere the happiest people are the ultra-religious and cult members. Everything is explained and everything is simple to them as a singular and unquestionable authority gives them all the answers. Therapy in the western tradition is pretty much the opposite of that. I guess you have to ask yourself if you want to be delusional and happy or realistic and perhaps have a good chance at being content with life and with occasional happiness and accepting of negative situations when they come. I suspect most people's idea of a mentally healthy person don't fit in with what its actually like to be mentally healthy. Its not all smiles and laughter. Its also toughness and resiliency and the ability to say 'no' to you. If your friend came back from therapy like this, you'd think it was a failure, but I suspect he feels much more validated in life and much more autonomous.
Shank 10y ago
It's worth noting that in the article, they too express some surprise at their results: > The most pressing issue that emerges is why these results run counter to the hundreds of more controlled, clinical intervention studies, which largely show positive effects of therapy not only on measures of distress and well-being, but also personality traits. In addition, the discussion section states: > Thus, whereas individuals reported seeing a therapist in our observational research, they may not have seen them long enough to induce positive change. Further, it could be that some people started therapy because of a traumatic life event and actually declined at a less rapid rate than if they had not sought therapy. As always, I think the answer is to wait and see. While they've noticed a correlation in two studies, it isn't that they've contradicted all of the prior evidence about therapy. Still, a neat read though.
civilian 10y ago
PDF download link: http://dx.doi.org.sci-hub.cc/10.1016/j.jrp.2017.02.002 http://dx.doi.org.sci-hub.cc/10.1016/j.jrp.2017.02.002 If you're new to scientific papers, the heuristic to use is: Read the Abstract, Introduction, and the Discussion/Conclusion. Methods & Results are boring and numbery, and you can dive into those later. I highly recommend reading the whole General Discussion section. It's four pages. The main idea is that: - There are previous well-controlled studies that show the benefits of therapy, but - When we are simply observing a cohort of people, the people who have some form of therapy experience a decline in positive indicators and a rise in negative indicators. (Indicators like self-esteem, depression, etc) This might be because: 1. The therapy did help, relatively, but because of the strong force from a patient's trauma, they were still generally doing poorly. But it could have been worse. 2. Because of the broad definition of "therapy experience" and the limited data in the survey, maybe this is mostly capturing people who only received a few sessions, and didn't continue long enough to receive the benefits, or in the case of the US cohort, only received drugs. 3. Maybe everyday therapists are kinda shitty? The therapists selected for controlled studies are always up to date with modern techniques. The paper said it more eloquently: > The third explanation concerns therapists who deliver therapy. Again, in a controlled intervention, treatment integrity is often one of the highest priorities of the research protocol. In contrast, implementation of empirically supported therapy in real-world settings may not happen with as much structure or rigor. I think these are all good hypotheses, but the 3rd explanation is pretty scandalous.
- deleted 10y ago
  [deleted]
- kolinko 10y ago
  Many therapists I met don't grasp psychiatry, and if a patient with a psychiatric problems comes to them, they will not be equipped to recognise the underlying issue. Hence, even with the best therapist, the patient may be fighting an uphill battle. Also, many patients are hard to convince that medication may be helpful, so again - uphill battle. Finally, for some issues we know that they have a strong genetic component (Anorexia?), but there are no good medications for it yet. I imagine that controlled studies correct for underlying psychiatric symptoms, but in real practice this is often omitted. Kind of like the point #3 you mentioned. From personal experience: I had some amazing therapists over the years. Really good, helped me with all the issues and traumas I had in my life. But until I got diagnosed with ADHD and received proper medication, my life was indeed getting worse and worse. The therapists helped me to get water out of a ship, but it was a psychiatrist who helped me find out the hole and patch it up.
kazinator 10y ago
Scratching scabs positively correlates with increased bleeding and healing time.
KKKKkkkk1 10y ago
A few years back, there was a prestigious psychology journal that published a paper about extrasensory perception. I'm wondering whether the extrasensory-psychology journals are distinct from the clinical-psychology journals, or do they have the same levels of scientific rigor?
deleted 10y ago
[deleted]
deleted 10y ago
[deleted]
laughfactory 10y ago
I've previously experienced two kinds of therapy: one which emphasized the "what do you feel, why do you feel like that, what or who caused you to feel this way", and one which completely disregarded the past, who was to blame, etc. and which instead focused on what actions I was presently taking, and what positive outcomes resulted from my actions. Guess which method worked. Unfortunately, I think a lot of the therapy out there is the first type, which for me, and most (I suspect), just makes the negative spiral worse. You spend MORE time thinking about what's wrong with you then you did before (if that were possible). The second approach was life changing for me. I learned to let go of the past, and focus on what I'm doing which works (which, surprise surprise, leads to more of such behavior). And interestingly enough, the therapy was relatively short term: something like three months, once a week. And that was almost ten years, marriage, and three kids ago--and I'm still practicing to good effect what I learned in that brief time. So my advice to anyone who will listen who's in therapy or interested in it is this: seek out a counselor or therapist who focuses on short term therapy which focuses on present action and positive (desirable to you) outcomes. Every other approach, IMHO, is a waste of time and money...And may make you more worse off in the end. These people can be hard to find, but they're worth their weight in gold.

82 points by whitepoplar 10y ago

Causal statement in the headline. You might think only correlational statement on paper, and this is somewhat true but it is a controlled ecologicalish study. no random assignment. bad temporal proximity of data gathering on personality. methodological poking about at the badness of controlled vs observational studies. basically study recruitment as a selection effect.

maxander 10y ago
They do perform a statistical analysis ("propensity score matching") to try to control for off-target correlations, but its true that the entire strength of the paper revolves around this having been done correctly and it being sufficient. Given the fact that improperly controlling for confounding factors could entirely account for their data (people whose personality traits are deteriorating are likely to have some awareness of this, and therefore to seek therapy) you would think that an account of this procedure would be front-in-center of their argument- but no, all details of that step are relegated to supplemental data for some reason. It's also worth noting that data collection was entirely done through surveys; so, another explanation could be that therapy simply made people more aware of pre-existing personality deficits, that they were then able to more accurately report. And further, even if the results are valid, it doesn't invalidate the benefits of therapy; most therapy methods are built around helping the patient. Its possible that therapy improves the subjective quality of the patient's life at the expense of some external qualities (or pretense thereof.)
- civilian 10y ago
  > Its possible that therapy improves the subjective quality of the patient's life at the expense of some external qualities (or pretense thereof.) That's not the case-- they were measuring for subjective quality, and it was subjective quality that declined. I posted the PDF of the paper in my top-level comment, but the Psychological measurements they were looking at in the German cohort were self-esteem, life satisfaction, and depression. The US cohort was measured for self-esteem, chronic stressors, and depression.
sctb 10y ago
Thanks, we've updated the headline from “On average, psychotherapy brings about undesirable changes in personality”.
- KingMob 10y ago
  Huh? I don't have access to the full article; is it about therapy in general or psychotherapy in particular?
ouid 10y ago
not to mention that an equally explanatory representation of the data is: "Pathological behavior is correlated with worsening pathological behavior"
- curuinor 10y ago
  Not as explanatory. There would have been no difference from the ecological control then

benevol 10y ago

On a related note, educate yourself fully about LSD. Then make your fully educated decision on whether to go ahead or not.

Kenji 10y ago
One is never fully educated until after the fact ;)
- klibertp 10y ago
  That might have been the point.
metaphorm 10y ago
related to your related note (which should have been less coy, and perhaps more informative): Those interested might be well advised to read their history and learn about the work that Stan Grof and Walter Pahnke were doing before the drug war crackdown.

coffeemug 10y ago

That doesn't surprise me. Anecdotally, everyone I know who is on a "self-discovery" quest never seems to discover anything or actually get happier. They tend to stay miserable and keep looking indefinitely. The people I know who do improve tend to stop looking and start doing (exercise, learning new things, etc.).

dwringer 10y ago
I like how you contradicted the main point of your second sentence in the third sentence.
- andai 10y ago
  I imagine by self-discovery OP meant "thinking about / deciding what to do", rather than actually doing things.
_yosefk 10y ago
It could be that people telling others about such quests seem to fail in those quests. Not sure most people seeking therapy for issues greatly bothering them are going to tell you.
SubiculumCode 10y ago
Neither am I. Ruminating on how we are deficient is no path to happiness or balance. Exercise, eat right, volunteer to serve others who are down and out, learn something new, work toward a purpose or goal, and if necessary, get pharmaceutical help, because for some no lifestyle or conduct can help enough.
- DanBC 10y ago
  The entire point of modern evidence based therapy is to help stop people ruminating on how they feel deficient.
  - SubiculumCode 10y ago

temp246810 10y ago

It's a shame that stuff like this makes it to the top of HN. Not because the content itself is good or bad, but because it is precisely someone struggling with this stuff who has a high likelihood of walking away from the article with the wrong message. I understand that we're all responsible for our decisions etc., but this is really out of our wheel house and hopefully the people in need of therapy consult with professionals before acting on anything that bubbles up here.

benevol 10y ago
> hopefully the people in need of therapy consult with professionals If your health care system gives you the option, that is.
- epmaybe 10y ago
  What do you mean?
  - Nomentatus 10y ago
    Refusal. I've heard of that happening with the original "Catch-22"!
  - _null 10y ago
    A lot of people simply don't have access to psychotherapy. Many national healthcare systems and health insurers have very limited provision. Many people in the US are uninsured or have very limited access to insurance-funded psychotherapy, despite the MHPAEA and the ACA. Here in the UK, someone diagnosed with depression or anxiety by their primary care physician is likely to receive no more than six sessions of CBT, often after a wait of many months. Private psychotherapy costs £60-£100 per session, which is totally unaffordable for many people. We have a chronic shortage of psychiatric inpatient beds and very poor follow-up care. People who are hospitalised after a suicide attempt are often discharged the same day with little more than a prescription for antidepressants and the promise of a home visit by a community nurse. Sadly, the UK isn't an outlier.

zellyn 10y ago

Can someone with more insight in this field tell me whether this is the same as claiming that people who have heart surgery tend to suffer more subsequent declines in cardiac health compared to those who never needed heart surgery?

Mizza 10y ago
It might be more apt to say something like those who opted for an elective colonic irrigation ended up with higher rates of impacted bowels.

cavanasm 10y ago

Is there a non-paywalled version of this? The abstract seems painfully vague to me, or is there some domain specific explanation for desirable vs undesirable personality traits? Are they literally saying that therapy makes whatever people are in therapy for worse?

DashRattlesnake 10y ago
Have you tried Sci-Hub? https://en.wikipedia.org/wiki/Sci-Hub https://en.wikipedia.org/wiki/Sci-Hub
deleted 10y ago
[deleted]

taurath 10y ago

So say you successfully make a change to one or more personality traits - I'd expect self esteem to go down, stress to go up and all the negativity experienced to happen. Changing personality isn't like putting on prescription lenses, it's like changing from green to red glasses. Things can become harder for a long time after a perspective change - most studies I've seen on CBT for example show it's still good for longer term outcomes.

shirleman 10y ago

Are they implying correlation or causation? It seems like you would need a control group with a psychological issue that doesn't do psychotherapy compared to one who does. If someone is in psychotherapy, presumably, they could be in a deteriorating mental state. It's like saying a cancer patient that does chemo feels worse. That's how cancer works. An assumption of steady-state psychology of a person just doesn't make sense to me. Not gonna pay $40 to read and see if I'm right tho...

programminggeek 10y ago

Focusing inward on problems and negativity is a great way to increase the feelings of negativity and hopelessness. Instead, ignoring the how and why of a crap situation and simply working to improve your situation will improve your outlook on it. Do stuff to make life better and you will feel better as if by magic. Just ignore the problems until they manage to disappear on their own. One step in front of the other. 1 > 0.

Nomentatus 10y ago
I do believe there's research on PTSD showing this, if you could find it you might reverse being voted down. But there's evidence in favor of the opposite of the action you propose - people who see their problems and reversals as external and don't bother too much about them are much less prone to depression, according to the data. That doesn't mean they are successful or nice, of course.
DanBC 10y ago
> Focusing inward on problems and negativity is a great way to increase the feelings of negativity and hopelessness. Repeating an earlier comment: the entire point of modern evidence based therapies is to help people avoid focusing inward on problems and negativity.
pekk 10y ago
People with real problems like major clinical depression, severe anxiety that prevents them from leaving the house, schizophrenia, etc. aren't going to be suddenly cured now that you have told them "1 > 0" and all they have to do is put "one step in front of the other." "Just ignore the problems" doesn't work for people who have problems which are, you know, actually serious.

rrggrr 10y ago

People alone with their negative thoughts do real damage to themselves and others. Therapy is the only and/or and appropriate resource for many of those people. Negative attributes from therapy? Without a doubt it says more about the modalities, and even the therapists than the patients.

drzaiusapelord 10y ago
Not to mention, from my own perspective as a therapy goer, a lot of personal and mental problems stem from a certain lack of social skills or immaturity, as well as working through trauma or biological mental illness (I have all three). Yes, you might come back from therapy a lot more assertive and "mean" than you were before, but its important to note you were maddeningly depressive and a zombie-like 'yes man/woman' before. This reminds me a bit of the movie Awakenings, where one of the patients who came out of his coma was upsetting his mother. His mother was so used to him being this passive and lovable manchild that she couldn't handle him when he became assertive, spoke back to her, and wanted to spend time with young ladies and not with his mother. She never saw him go through a proper teenage rebellion stage and he wanted to live life immediately and really had no time for mother anymore because he just wanted to pursue his crush. To his mother, the therapy was a failure because she was no longer happy with him. I also think there's an element of becoming jaded as one gets older, generally. The more experience you have with people, life, etc the more you realize we really are not good creatures and a lot of the wonderful optimism we've been taught be in a spiritual, social, or familial environment are often wrong, if not entirely false and people are just simply predictable animals fighting for resources. Therapy and other methods of self-discovery often lead to these self-discoveries and can really lead to a certain level of 'depressive realism.' I read somewhere the happiest people are the ultra-religious and cult members. Everything is explained and everything is simple to them as a singular and unquestionable authority gives them all the answers. Therapy in the western tradition is pretty much the opposite of that. I guess you have to ask yourself if you want to be delusional and happy or realistic and perhaps have a good chance at being content with life and with occasional happiness and accepting of negative situations when they come. I suspect most people's idea of a mentally healthy person don't fit in with what its actually like to be mentally healthy. Its not all smiles and laughter. Its also toughness and resiliency and the ability to say 'no' to you. If your friend came back from therapy like this, you'd think it was a failure, but I suspect he feels much more validated in life and much more autonomous.

Shank 10y ago

It's worth noting that in the article, they too express some surprise at their results: > The most pressing issue that emerges is why these results run counter to the hundreds of more controlled, clinical intervention studies, which largely show positive effects of therapy not only on measures of distress and well-being, but also personality traits. In addition, the discussion section states: > Thus, whereas individuals reported seeing a therapist in our observational research, they may not have seen them long enough to induce positive change. Further, it could be that some people started therapy because of a traumatic life event and actually declined at a less rapid rate than if they had not sought therapy. As always, I think the answer is to wait and see. While they've noticed a correlation in two studies, it isn't that they've contradicted all of the prior evidence about therapy. Still, a neat read though.

civilian 10y ago

PDF download link: http://dx.doi.org.sci-hub.cc/10.1016/j.jrp.2017.02.002 http://dx.doi.org.sci-hub.cc/10.1016/j.jrp.2017.02.002 If you're new to scientific papers, the heuristic to use is: Read the Abstract, Introduction, and the Discussion/Conclusion. Methods & Results are boring and numbery, and you can dive into those later. I highly recommend reading the whole General Discussion section. It's four pages. The main idea is that: - There are previous well-controlled studies that show the benefits of therapy, but - When we are simply observing a cohort of people, the people who have some form of therapy experience a decline in positive indicators and a rise in negative indicators. (Indicators like self-esteem, depression, etc) This might be because: 1. The therapy did help, relatively, but because of the strong force from a patient's trauma, they were still generally doing poorly. But it could have been worse. 2. Because of the broad definition of "therapy experience" and the limited data in the survey, maybe this is mostly capturing people who only received a few sessions, and didn't continue long enough to receive the benefits, or in the case of the US cohort, only received drugs. 3. Maybe everyday therapists are kinda shitty? The therapists selected for controlled studies are always up to date with modern techniques. The paper said it more eloquently: > The third explanation concerns therapists who deliver therapy. Again, in a controlled intervention, treatment integrity is often one of the highest priorities of the research protocol. In contrast, implementation of empirically supported therapy in real-world settings may not happen with as much structure or rigor. I think these are all good hypotheses, but the 3rd explanation is pretty scandalous.

deleted 10y ago
[deleted]
kolinko 10y ago
Many therapists I met don't grasp psychiatry, and if a patient with a psychiatric problems comes to them, they will not be equipped to recognise the underlying issue. Hence, even with the best therapist, the patient may be fighting an uphill battle. Also, many patients are hard to convince that medication may be helpful, so again - uphill battle. Finally, for some issues we know that they have a strong genetic component (Anorexia?), but there are no good medications for it yet. I imagine that controlled studies correct for underlying psychiatric symptoms, but in real practice this is often omitted. Kind of like the point #3 you mentioned. From personal experience: I had some amazing therapists over the years. Really good, helped me with all the issues and traumas I had in my life. But until I got diagnosed with ADHD and received proper medication, my life was indeed getting worse and worse. The therapists helped me to get water out of a ship, but it was a psychiatrist who helped me find out the hole and patch it up.

kazinator 10y ago

Scratching scabs positively correlates with increased bleeding and healing time.

KKKKkkkk1 10y ago

A few years back, there was a prestigious psychology journal that published a paper about extrasensory perception. I'm wondering whether the extrasensory-psychology journals are distinct from the clinical-psychology journals, or do they have the same levels of scientific rigor?

deleted 10y ago

[deleted]

deleted 10y ago

[deleted]

laughfactory 10y ago

I've previously experienced two kinds of therapy: one which emphasized the "what do you feel, why do you feel like that, what or who caused you to feel this way", and one which completely disregarded the past, who was to blame, etc. and which instead focused on what actions I was presently taking, and what positive outcomes resulted from my actions. Guess which method worked. Unfortunately, I think a lot of the therapy out there is the first type, which for me, and most (I suspect), just makes the negative spiral worse. You spend MORE time thinking about what's wrong with you then you did before (if that were possible). The second approach was life changing for me. I learned to let go of the past, and focus on what I'm doing which works (which, surprise surprise, leads to more of such behavior). And interestingly enough, the therapy was relatively short term: something like three months, once a week. And that was almost ten years, marriage, and three kids ago--and I'm still practicing to good effect what I learned in that brief time. So my advice to anyone who will listen who's in therapy or interested in it is this: seek out a counselor or therapist who focuses on short term therapy which focuses on present action and positive (desirable to you) outcomes. Every other approach, IMHO, is a waste of time and money...And may make you more worse off in the end. These people can be hard to find, but they're worth their weight in gold.