6 ms·

pfft I like to ask every doc I go to, what outcomes they have produced in cases like mine and how many such cases they see a year. The CBT ppl just blink at me

by gusts 8y ago

pfft I like to ask every doc I go to, what outcomes they have produced in cases like mine and how many such cases they see a year. The CBT ppl just blink at me like the question is not on their manual. And one even said no great outcomes but here are the things you should do. Why would I spend my time doing them if they haven't produced results? I mean these are nice people with good intentions but so is a priest in a church or a temple. The whole thing feels half baked. Ya ya I know reprogramming the mind is complex and this is a work in progress. But my experience from work and coaching team sports is people follow authority figures when in doubt/outcomes are unknown. And most shrinks and counsellors in my case atleast are unable to establish authority.

deleted 8y ago
[deleted]
smt88 8y ago
Outcomes are meaningless without control groups. The providers you spoke to may not have stunning reversals of illness to show you, but keeping someone from sliding into a worse state is an important function of therapy and impossible to measure. For all you know, they may have prevented dozens of suicides that year.
- nyolfen 8y ago
  for all we know they exacerbated their patients symptoms
  - smt88 8y ago
    Well, from the comment I was responding to, the implication I took from "no great outcomes" was "no great change, either positive or negative". But technically, yes, you're right.
boomboomsubban 8y ago
>And most shrinks and counsellors in my case atleast are unable to establish authority. If you continuously end up in situations where you're seeing mental health professionals, you might consider just accepting their authority without the need to jump through your hoops.
- pdpi 8y ago
  Speaking from experience, seems to me the GP’s need to make people jump through hoops to earn their trust is a damned important part of _why_ they need those professionals in the first place.
  - boomboomsubban 8y ago
    At a certain point you need to consider their success rate against your own. Realizing that and accepting they may be able to help is an important step.
    - pdpi 8y ago
      Right — but it’s a pretty damn big first step. I can think of a fair few people who were never capable of taking that step
      - jm__87 8y ago
        You can't help someone who doesn't want to help themselves.
        GW150914 8y ago
        I mean, if someone is shot, you can still surgically intervene without them having to participate. It’s true in psych that you have to help yourself, but it’s also true that’s probsbly a valid critique of the art rather than science that is psych. Talk therapy has more in common with spiritual guidance or shamanism than medicine, except where the actual medicine enters the fray in the form of drugs and surgery. If you’re willing to help yourself, talking to someone is often helpful, but that’s been known for thousands of years. A real intervention doesn’t require someone to help themselves; an appendectomy doesn’t require patient participation and motivation.
        jm__87 8y ago
        I mean, if someone is shot, you can still surgically intervene without them having to participate. Okay, this is clearly not what we were talking about. Sorry I was not more specific in my statement to generalize to all scenarios, ever. Edit: I think it is also a pretty fair assumption that if someone is shot or their appendix is about to burst, they would want help. The key difference here is that someone who is shot is not capable of helping themselves - with regards to many things people go to therapy for, the only way to fix your problems is going to be taking some actions yourself.
overton 8y ago
+1 I'm pretty sure multiple rounds of CBT made my anxiety disorders worse. The approach attracts hyper-rationalist types who aren't willing to say anything other than "Your thinking patterns are wrong, you need to fix them." No serious discussion of trauma, identity issues, or relationships. Pure gaslighting. Recently, I finally realized that what I needed was some serious introspection and an empathetic therapist who would help me work through it. For all the bluster about psychoanalysis being quackery, I'm not sure you can disagree with its basic premise that maladaptive personality traits are likely to come from the social context you spent most of your first ~18 years in.
- jm__87 8y ago
  Wouldn't many of your thinking patterns have come from your childhood and teenage years? How did none of this come up when you did CBT? Also, how did you do CBT without serious introspection? It sounds like the therapist you did CBT with just wasn't very good.
- nickwalton00 8y ago
  I've found that for my anxiety ERP based therapy is much more effective because often anxiety isn't a matter of your rational brains understanding but rather trained responses of your subconscious.
DanBC 8y ago
It's frustrting when you ask someone how they know this works or how effective it is and they give you blank looks. It feels like a failure of informed consent. > The CBT ppl just blink at me like the question is not on their manual. What country? In England the IAPT programme (the main source of CBT) has extensive data collection on outcomes (probably the largest collection in the world) and a focus on getting more and better evidence to improve the service. Chapter 3 and 6 of the IAPT manual are about evidence based practice and gathering better data: https://www.england.nhs.uk/wp-content/uploads/2018/06/the-iapt-manual.pdf https://www.england.nhs.uk/wp-content/uploads/2018/06/the-ia... The data sets are here: https://digital.nhs.uk/data-and-information/publications/statistical/psychological-therapies-report-on-the-use-of-iapt-services https://digital.nhs.uk/data-and-information/publications/sta... The latest (Jun 12 2018) says this ---begin quote--- Key Facts In April 2018 there were: -- 119,304 new referrals; -- 85,145 referrals that entered treatment; -- 47,296 referrals that finished a course of treatment, of which; -- 89.4 per cent waited less than 6 weeks and 98.9 per cent waited less than 18 weeks to enter treatment; -- 44,222 started their treatment at caseness, with 51.9 per cent moving to recovery. ---end quote--- There's some jargon there, but that's explained in the executive summary: https://files.digital.nhs.uk/D3/B3FC5F/iapt-month-apr-2018-exec-sum.pdf https://files.digital.nhs.uk/D3/B3FC5F/iapt-month-apr-2018-e... tl;dr: CBT is somewhat effective; it's more effective if you have CBT that follows the high intensity model (14 to 20 weeks, one hour per week, face to face one to one with a qualified therapist).

by gusts 8y ago

deleted 8y ago

[deleted]

smt88 8y ago

Outcomes are meaningless without control groups. The providers you spoke to may not have stunning reversals of illness to show you, but keeping someone from sliding into a worse state is an important function of therapy and impossible to measure. For all you know, they may have prevented dozens of suicides that year.

nyolfen 8y ago
for all we know they exacerbated their patients symptoms
- smt88 8y ago
  Well, from the comment I was responding to, the implication I took from "no great outcomes" was "no great change, either positive or negative". But technically, yes, you're right.

boomboomsubban 8y ago

>And most shrinks and counsellors in my case atleast are unable to establish authority. If you continuously end up in situations where you're seeing mental health professionals, you might consider just accepting their authority without the need to jump through your hoops.

pdpi 8y ago
Speaking from experience, seems to me the GP’s need to make people jump through hoops to earn their trust is a damned important part of _why_ they need those professionals in the first place.
- boomboomsubban 8y ago
  At a certain point you need to consider their success rate against your own. Realizing that and accepting they may be able to help is an important step.
  - pdpi 8y ago
    Right — but it’s a pretty damn big first step. I can think of a fair few people who were never capable of taking that step
    - jm__87 8y ago
      You can't help someone who doesn't want to help themselves.
      - GW150914 8y ago
        I mean, if someone is shot, you can still surgically intervene without them having to participate. It’s true in psych that you have to help yourself, but it’s also true that’s probsbly a valid critique of the art rather than science that is psych. Talk therapy has more in common with spiritual guidance or shamanism than medicine, except where the actual medicine enters the fray in the form of drugs and surgery. If you’re willing to help yourself, talking to someone is often helpful, but that’s been known for thousands of years. A real intervention doesn’t require someone to help themselves; an appendectomy doesn’t require patient participation and motivation.
        jm__87 8y ago
        I mean, if someone is shot, you can still surgically intervene without them having to participate. Okay, this is clearly not what we were talking about. Sorry I was not more specific in my statement to generalize to all scenarios, ever. Edit: I think it is also a pretty fair assumption that if someone is shot or their appendix is about to burst, they would want help. The key difference here is that someone who is shot is not capable of helping themselves - with regards to many things people go to therapy for, the only way to fix your problems is going to be taking some actions yourself.

overton 8y ago

+1 I'm pretty sure multiple rounds of CBT made my anxiety disorders worse. The approach attracts hyper-rationalist types who aren't willing to say anything other than "Your thinking patterns are wrong, you need to fix them." No serious discussion of trauma, identity issues, or relationships. Pure gaslighting. Recently, I finally realized that what I needed was some serious introspection and an empathetic therapist who would help me work through it. For all the bluster about psychoanalysis being quackery, I'm not sure you can disagree with its basic premise that maladaptive personality traits are likely to come from the social context you spent most of your first ~18 years in.

jm__87 8y ago
Wouldn't many of your thinking patterns have come from your childhood and teenage years? How did none of this come up when you did CBT? Also, how did you do CBT without serious introspection? It sounds like the therapist you did CBT with just wasn't very good.
nickwalton00 8y ago
I've found that for my anxiety ERP based therapy is much more effective because often anxiety isn't a matter of your rational brains understanding but rather trained responses of your subconscious.

DanBC 8y ago

It's frustrting when you ask someone how they know this works or how effective it is and they give you blank looks. It feels like a failure of informed consent. > The CBT ppl just blink at me like the question is not on their manual. What country? In England the IAPT programme (the main source of CBT) has extensive data collection on outcomes (probably the largest collection in the world) and a focus on getting more and better evidence to improve the service. Chapter 3 and 6 of the IAPT manual are about evidence based practice and gathering better data: https://www.england.nhs.uk/wp-content/uploads/2018/06/the-iapt-manual.pdf https://www.england.nhs.uk/wp-content/uploads/2018/06/the-ia... The data sets are here: https://digital.nhs.uk/data-and-information/publications/statistical/psychological-therapies-report-on-the-use-of-iapt-services https://digital.nhs.uk/data-and-information/publications/sta... The latest (Jun 12 2018) says this ---begin quote--- Key Facts In April 2018 there were: -- 119,304 new referrals; -- 85,145 referrals that entered treatment; -- 47,296 referrals that finished a course of treatment, of which; -- 89.4 per cent waited less than 6 weeks and 98.9 per cent waited less than 18 weeks to enter treatment; -- 44,222 started their treatment at caseness, with 51.9 per cent moving to recovery. ---end quote--- There's some jargon there, but that's explained in the executive summary: https://files.digital.nhs.uk/D3/B3FC5F/iapt-month-apr-2018-exec-sum.pdf https://files.digital.nhs.uk/D3/B3FC5F/iapt-month-apr-2018-e... tl;dr: CBT is somewhat effective; it's more effective if you have CBT that follows the high intensity model (14 to 20 weeks, one hour per week, face to face one to one with a qualified therapist).