3 ms·

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 pa

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.
AnotherHustler 10y ago
Additionally, the study does not differentiate between therapy types received - treatment modalities vary in efficacy depending on person and context. For example, 20 years ago it was known within psychology that "Cognitive Therapy" had about a 50/50 success rate. However, if you try to apply cognitive therapy to someone diagnosed with borderline personality disorder - it's not likely to work ever - and might actually make things worse (Dialectic Behavioural Therapy is probably the gold standard for this). As you travel down the road towards being a psych. professional - you tend to subscribe a school of thought about behavior and personality, and there are a few to choose from (e.g. people are generally self-directed and will solve their own problems given the opportunity, or behavioural problems have their roots in learning - so training is required) - and depending on your opinion you'll eventually subscribe to a treatment modality that resonates with what you believe (the extreme version of this is abandoning psychology & switching to medicine / psychiatry because you believe behavior is simply a neurochemical process). Serious personality disorders are very difficult to treat, which brings me to my next point. The Big-Five factor model used to determine change over time does not factor diagnosis, so we don't really get a picture of what the cohort looks like. We know nothing about patient history or reason for seeking therapy (i.e. have you been evaluated admitted to a psychiatric ward in the past? have you suffered from substance abuse problems?). And finally, the big question that would be useful is "what problems caused you to seek therapy?" Depression vs. hearing voices in one's head vs. got divorced because I like to drink are all very different issues. I would like to have seen at least three more measures: reason for treatment, length of treatment and therapy modality used. However, I will say that stating that "new research proves that therapy doesn't work" will get you a click or two ;-)

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.

AnotherHustler 10y ago

Additionally, the study does not differentiate between therapy types received - treatment modalities vary in efficacy depending on person and context. For example, 20 years ago it was known within psychology that "Cognitive Therapy" had about a 50/50 success rate. However, if you try to apply cognitive therapy to someone diagnosed with borderline personality disorder - it's not likely to work ever - and might actually make things worse (Dialectic Behavioural Therapy is probably the gold standard for this). As you travel down the road towards being a psych. professional - you tend to subscribe a school of thought about behavior and personality, and there are a few to choose from (e.g. people are generally self-directed and will solve their own problems given the opportunity, or behavioural problems have their roots in learning - so training is required) - and depending on your opinion you'll eventually subscribe to a treatment modality that resonates with what you believe (the extreme version of this is abandoning psychology & switching to medicine / psychiatry because you believe behavior is simply a neurochemical process). Serious personality disorders are very difficult to treat, which brings me to my next point. The Big-Five factor model used to determine change over time does not factor diagnosis, so we don't really get a picture of what the cohort looks like. We know nothing about patient history or reason for seeking therapy (i.e. have you been evaluated admitted to a psychiatric ward in the past? have you suffered from substance abuse problems?). And finally, the big question that would be useful is "what problems caused you to seek therapy?" Depression vs. hearing voices in one's head vs. got divorced because I like to drink are all very different issues. I would like to have seen at least three more measures: reason for treatment, length of treatment and therapy modality used. However, I will say that stating that "new research proves that therapy doesn't work" will get you a click or two ;-)