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Perception of psychotherapeutic progress does not equal progress. Anyone can convince themselves of almost anything, for any number of reasons. Including convic

Perception of psychotherapeutic progress does not equal progress. Anyone can convince themselves of almost anything, for any number of reasons. Including convicning themselves of a therapeutic effect. Conversely, "therapeutic" processing of trauma often occurs subconsciously. Such as during sleep, and arguably more so as sleep quality improves. Instead of looking for benefit, at least for now, the concentration should be on an assessment of harm. Only in that context will a future study on possible benefit be informative.

jakubmazanec 3y ago
> Anyone can convince themselves of almost anything, for any number of reasons. Including convicning themselves of a therapeutic effect. This is a weird take. If a person is suicidal, and "convinces himself" (whatever that actually means in the context of the therapy) to not kill themself, this is therapeutic effect by definition.
- zdragnar 3y ago
  I agree that it is a weird take, but your analogy is off. The actual therapeutic effect would be stopping suicidal ideation, not a single instance of suicidal behavior. A person may continue to suffer whatever ill effects that were pushing them to suicide but (temporarily) reconsider the action itself. On the one hand, nobody can "fix" you; you need to internalize different ways of thinking and build emotional resilience. Drugs may help this process, or help maintain it, but they're not a cure, and neither is talk therapy. It is, in a sense, a matter of convincing yourself. On the other hand, most people- even very introspective people- will struggle with self-therapy. It isn't as easy as "today I am happy".
  - jakubmazanec 3y ago
    > The actual therapeutic effect would be stopping suicidal ideation Well, yeah, that's what I meant and that what's the article is about (e.g. the story of Hana K.).
- mrangle 3y ago
  I disagree that it is a weird take. As your logic is incomplete, respectfully. I didn't mean to imply that being convinced of therapeutic benefit always means that there isn't any. There could even be a lot of benefit. I meant to state or imply that being convinced doesn't necessarily mean that such a benefit was significant, if there at all. This means that someone convinced of such benefit may have that benefit, but not necessarily. Respectfully, using a binary life and death measurement example only means that you've cited a circumstance where we can definitely measure when there has been a significant benefit. Assuming that we can conclude that suicide was otherwise likely (we can assume that for this hypothetical). Take another example: A person can momentarily convince themself that their PSD is healed, even just out of positive self-talk, a single good therapy experience, and hope, and then go on to realize continuing debilitating symptoms for their lifetime. What the experimental use of currently illicit street drugs in psychotherapy should be measuring, assuming that we can agree that we should be conducting such experiemnts (I don't agree given the available research), is whether or not they may make conditions such as PSD worse over the coming decades. In spite of patient verbal feedback at any point in time. Because people like street drugs, in general. When was the lsat time that you witnessed an enthusiastic or otherwise "therapuetic" user of street drugs lamenting the thinning of their cortical white matter? Or lamenting the loss of other brain architecture that theoretically would help them overcome mental illness should it survive their habit?
  - jakubmazanec 3y ago
    Thanks for elaborating your point further. > I disagree that it is a weird take. You say "Perception of psychotherapeutic progress does not equal progress.", but the article ends with Hana K. doing objectively better that before her therapy, decades (!) later. It simply isn't just perception. > A person can momentarily convince themself that their PSD is healed, even just out of positive self-talk, a single good therapy experience, and hope, and then go on to realize continuing debilitating symptoms for their lifetime. Well, yeah, obviously. Have you read any protocol that is actually used during these types of experimental therapies using MDMA or psilocybin? The patient doesn't undergo just single session, and regular talking therapy is also administered, in multiple sessions. > is whether or not they may make conditions such as PSD worse over the coming decades. I agree that this should be also studied. And I'm sure it already is. The re-emergence of using psychoactive substances is a trend that is only a few years old. So sure, the current effect (which are statistically huge) may not last forever, but again based on this article, I think the effects will last.

jakubmazanec 3y ago

> Anyone can convince themselves of almost anything, for any number of reasons. Including convicning themselves of a therapeutic effect. This is a weird take. If a person is suicidal, and "convinces himself" (whatever that actually means in the context of the therapy) to not kill themself, this is therapeutic effect by definition.

zdragnar 3y ago
I agree that it is a weird take, but your analogy is off. The actual therapeutic effect would be stopping suicidal ideation, not a single instance of suicidal behavior. A person may continue to suffer whatever ill effects that were pushing them to suicide but (temporarily) reconsider the action itself. On the one hand, nobody can "fix" you; you need to internalize different ways of thinking and build emotional resilience. Drugs may help this process, or help maintain it, but they're not a cure, and neither is talk therapy. It is, in a sense, a matter of convincing yourself. On the other hand, most people- even very introspective people- will struggle with self-therapy. It isn't as easy as "today I am happy".
- jakubmazanec 3y ago
  > The actual therapeutic effect would be stopping suicidal ideation Well, yeah, that's what I meant and that what's the article is about (e.g. the story of Hana K.).
mrangle 3y ago
I disagree that it is a weird take. As your logic is incomplete, respectfully. I didn't mean to imply that being convinced of therapeutic benefit always means that there isn't any. There could even be a lot of benefit. I meant to state or imply that being convinced doesn't necessarily mean that such a benefit was significant, if there at all. This means that someone convinced of such benefit may have that benefit, but not necessarily. Respectfully, using a binary life and death measurement example only means that you've cited a circumstance where we can definitely measure when there has been a significant benefit. Assuming that we can conclude that suicide was otherwise likely (we can assume that for this hypothetical). Take another example: A person can momentarily convince themself that their PSD is healed, even just out of positive self-talk, a single good therapy experience, and hope, and then go on to realize continuing debilitating symptoms for their lifetime. What the experimental use of currently illicit street drugs in psychotherapy should be measuring, assuming that we can agree that we should be conducting such experiemnts (I don't agree given the available research), is whether or not they may make conditions such as PSD worse over the coming decades. In spite of patient verbal feedback at any point in time. Because people like street drugs, in general. When was the lsat time that you witnessed an enthusiastic or otherwise "therapuetic" user of street drugs lamenting the thinning of their cortical white matter? Or lamenting the loss of other brain architecture that theoretically would help them overcome mental illness should it survive their habit?
- jakubmazanec 3y ago
  Thanks for elaborating your point further. > I disagree that it is a weird take. You say "Perception of psychotherapeutic progress does not equal progress.", but the article ends with Hana K. doing objectively better that before her therapy, decades (!) later. It simply isn't just perception. > A person can momentarily convince themself that their PSD is healed, even just out of positive self-talk, a single good therapy experience, and hope, and then go on to realize continuing debilitating symptoms for their lifetime. Well, yeah, obviously. Have you read any protocol that is actually used during these types of experimental therapies using MDMA or psilocybin? The patient doesn't undergo just single session, and regular talking therapy is also administered, in multiple sessions. > is whether or not they may make conditions such as PSD worse over the coming decades. I agree that this should be also studied. And I'm sure it already is. The re-emergence of using psychoactive substances is a trend that is only a few years old. So sure, the current effect (which are statistically huge) may not last forever, but again based on this article, I think the effects will last.