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OMFG, people! Therapy isn't pseudoscience. There is a shitload of evidence that it works. You don't get to wave around the reproducibility crisis like it's a ma

OMFG, people! Therapy isn't pseudoscience. There is a shitload of evidence that it works. You don't get to wave around the reproducibility crisis like it's a magic wand to make things that scare you go away. Now show me on the doll where therapy hurt you.

coldtea 2y ago
>There is a shitload of evidence that it works. As "verified" not by hard measurements (like in Physics), proofs (as in math), or specific clinical results (e.g. blood panels in medicine) but with questionaires and "assessments" by the very people whose continued existance and esteem of the field their careers are based on? "All kinds of evidence that it works" was there for Freudian psychanalysis too.
- tokai 2y ago
  >All kinds of evidence that it works was there for Freudian psychanalysis too. Not really, which is why it is all but gone from university psychology research.
  - coldtea 2y ago
    It's gone because it went out of fashion. The psychanalysis institutes at the time had all kinds of papers and results of their huge success...
    - piva00 2y ago
      That's true for most science though, biology had the same issues earlier in the 1800s-1900s until the field matured. It doesn't mean that all biology from that time was pseudoscience, it was wrong but paved the way to find the right answers. Psychology has its successes, empirically proven by getting results in clinical settings, we don't have deep answers on why some of it works or not but working known pharmaceutical compounds also suffer from that, we know they work but we don't know how (some NSAIDs come to mind, psychiatric meds, anesthesia as well).
    - benterix 2y ago
      It gets funnier than that! [0] > ... in 1952 in which H. J. Eyesenck, an English psychiatrist, divided thousands of World War II veterans hospitalized for mental illness into three groups. One group was treated by psychoanalysis, another was given other kinds of therapy, and the third received no treatment at all. The men were then measured on an "improvement scale" with these stunning results: 44 per cent improved with psychoanalysis, 64 per cent improved with other therapies, and 72 per cent got better with no treatment at all. > More recently, Werner Mendel, professor of psychiatry at the University of Southern California, directed a similar study. Trained psychoanalysts treated the patients in the first group, less highly trained psychologists and psychotherapists treated the second group, and the third group was under the care of employees with no formal training. The improvement ratings showed the following remarkable results: the third group, treated by staff members without formal training in therapy, showed the most improvement, whereas the first group, treated by staff members with the most extensive training in psychotherapy, showed the least improvement. Understandably, Dr. Mendel was startled by the results and repeated the experiment, with the same outcome. Now, I'm not going down this rabbit-hole (I did once and wasted a lot of time!) but there is a lot of evidence that just a bit of attention from another person may be helpful, and affective attention may work wonders. [0] https://www.religion-online.org/article/sin-guilt-and-mental-health-confession-and-restitution-as-means-of-therapy/ https://www.religion-online.org/article/sin-guilt-and-mental...
      - westurner 2y ago
        Which behaviors are reinforced more than a general level of consideration and positive regard? I hadn't heard of this study. I had heard that the case count for psychoanalytic psychotherapy was insufficient to fairly cluster by symptoms as (e.g. hierarchical) features, even. And then Milgram's selection bias. Is all "Talk Therapy" bad then, and what's a good way to actually help; Clean language > Clean language in detail: https://en.wikipedia.org/wiki/Clean_language#Clean_language_in_detail https://en.wikipedia.org/wiki/Clean_language#Clean_language_... : > Clean language offers a template for questions that are as free as possible of the facilitator's suggestions, presuppositions, mind-reading, second guessing, references and metaphors. Clean questions incorporate all or some of the client's specific phrasing and might also include other auditory components of the client's communication such as speed, pitch, tonality. Besides the words of the client, oral sounds (sighs, oo's and ah's) and other nonverbals (e.g. a fist being raised or a line-of-sight) can be replicated or referenced in a question when the facilitator considers they might be of symbolic significance to the client. > [...] "What would you like to have happen? Clean Language Questions : https://cleanlearning.co.uk/blog/discuss/clean-language-questions https://cleanlearning.co.uk/blog/discuss/clean-language-ques... : > The questions containing the verb ‘to be’ help to keep time still and are mostly used for developing individual perceptions: > Questions containing the verb ‘to happen’ generally encourage the client to move time forwards or backwards: > Questions which utilise other verbs are: A prompt: Leadership and Public Speaking: which can utilize Clean Language; and which are necessarily suggestive of direction, course, or sequalae of events?
    - tokai 2y ago
      Its still going, but not in public research institutes. It didn't go out of fashion - it couldn't deliver on the demands for quantitative evidence in modern clinical medicine. That modern psychology now has it's own problems just goes to show how much psychoanalysis is a genre of literature and not much more. Its weird that we are arguing this. The shift is well covered over the last half a decade. Also whats the point of lots of psychoanalytic papers being published? There exists a ton of string theory papers. Theology is a huge field, once the biggest academic discipline. Bullshit exist, so what.
- vidarh 2y ago
  I have a family member where my whatsapp history is a direct and concrete measure of their improved welfare after starting therapy: Our live conversations have largely been me dealing with the effects of OCD. Once they started therapy, the length of those conversations declined dramatically and rapidly, and while they still have some symptoms they are dealing with them far better. You could argue it's a coincidence, but it'd seem a highly unlikely one given the therapy was specifically to address that OCD, and the techniques they're using to reduce the frequency were taught by the therapist. And of course it is one anecdote. I have no doubt there are lots of people for whom therapy is insufficient or doesn't work, but there are also people for whom you can measure the effects in a lot of other ways than the judgment of therapists themselves.
  - coldtea 2y ago
    What's contested is not that some therapist or therapy sessions ever helped people. It's that it's scientific and systematic (and not e.g. arbitrary and subjective, whose efficacy is based on methodology but on the specific patient, the specific therapist, their rapport, and such things). Talking to a friend also helped many a person overcome psychological problems. As did getting a new job, working out, getting laid, and lots of other things. None of those things claim to be scientific fields though.
    - sseagull 2y ago
      > It's that it's scientific and systematic (and not e.g. arbitrary and subjective Care to enlighten us on a better way? We have people who need help right now, not when (or even if) we find some sort of objective test. Just because we can’t measure something objectively doesn’t mean it’s not important or useful (McNamara fallacy). I am a “hard” scientist (physical chemist), and like most (old-ish) scientists I have come to appreciate the “softer” side of life.
      - coldtea 2y ago
        >Care to enlighten us on a better way? We have people who need help right now, not when (or even if) we find some sort of objective test. Doesn't mean they are getting help. Just means we set up a whole cargo cult field from thin air and on thin premises, and make-pretend we help them. Meanwhile, more important structural changes to get them help, are of course ignored, because they are bad for bussiness or inconvenient (like better work-life-balance, less stressful educational/work/healthcare/late life prospects, more cohesive communities, better access to nature, less advertising and rage bait, and anything that doesn't help with the corporate mills grinding on).
- benterix 2y ago
  I don't believe it's 100% true for all therapies. CBT works exactly as you describe, although it's efficient only for specific problems. There might be other therapies I don't know about which are equally clinically tested as CBT.
- dbspin 2y ago
  I'm sorry but this is a classic example of experts in one field (assuming CS by virtue of posting on Hacker News) assuming that they know anything worth saying about another field. There actually is a mountain of quantitative outcome research across therapy approaches. It's readily readable in metastudy form on Google Scholar and elsewhere.
  - coldtea 2y ago
    >I'm sorry but this is a classic example of experts in one field (assuming CS by virtue of posting on Hacker News) assuming that they know anything worth saying about another field. Or maybe it's just a classic example of a pseudo-field? >There actually is a mountain of quantitative outcome research across therapy approaches "Quantitative outcomes" for non-quantifiable conditions means "numerical statistics on answers in questionaires" and such. >It's readily readable in metastudy form on Google Scholar and elsewhere. Ah, metastudies, that pinnacle of rigour. "We hastily surveyed 200 varying quality, full of methodological errors, non replicating for the most part, primary studies, and the field is totally a success".
    - dbspin 2y ago
      If you can't define a null hypothesis, you can't make a coherent or convincing argument. You're just restating your bias.
- dwb 2y ago
  What qualifications do you have that might add weight to your implied dismissal of more-or-less an entire field?
  - coldtea 2y ago
    Thankfully none collected from within the field.
    - dwb 2y ago
      I rest my case. Cartoonish levels of “hard”-science-nerd arrogance.
      - coldtea 2y ago
        Yeah, or as I call it "pragmatic levels of actual science dismisall of pseudo-sciences". Note how tye very same accusation as yours could be (and was made) for Freudian psychanalysis, homeopathy, and any other bs field.
- KingMob 2y ago
  > specific clinical results Uh, I have bad news for you about the reproducibility crisis that's also in medicine/biology. It's just like psychology but 100x worse because there's real money at stake.
pratio 2y ago
Therapy isn't pseudoscience but the reproducibility crisis is real. There's also the issue that if you change a therapist, their approach to treating, diagnosing a condition will change. With modern medicine, we have tests and reports and doctor's don't've that much of a leeway on how they treat a condition. We have medical malpractice lawsuits when doctor's go out of line. Like the parent mentioned, the reproducibility crisis didn't change anything, we also can't be sure how many doctors actually took these findings into account. The point I'm trying to make is that it is really difficult to identify bad therapists. It'll take a while before it's reliable enough and that's okay, but therapy gets thrown around as an option like it is.

coldtea 2y ago

>There is a shitload of evidence that it works. As "verified" not by hard measurements (like in Physics), proofs (as in math), or specific clinical results (e.g. blood panels in medicine) but with questionaires and "assessments" by the very people whose continued existance and esteem of the field their careers are based on? "All kinds of evidence that it works" was there for Freudian psychanalysis too.

tokai 2y ago
>All kinds of evidence that it works was there for Freudian psychanalysis too. Not really, which is why it is all but gone from university psychology research.
- coldtea 2y ago
  It's gone because it went out of fashion. The psychanalysis institutes at the time had all kinds of papers and results of their huge success...
  - piva00 2y ago
    That's true for most science though, biology had the same issues earlier in the 1800s-1900s until the field matured. It doesn't mean that all biology from that time was pseudoscience, it was wrong but paved the way to find the right answers. Psychology has its successes, empirically proven by getting results in clinical settings, we don't have deep answers on why some of it works or not but working known pharmaceutical compounds also suffer from that, we know they work but we don't know how (some NSAIDs come to mind, psychiatric meds, anesthesia as well).
  - benterix 2y ago
    It gets funnier than that! [0] > ... in 1952 in which H. J. Eyesenck, an English psychiatrist, divided thousands of World War II veterans hospitalized for mental illness into three groups. One group was treated by psychoanalysis, another was given other kinds of therapy, and the third received no treatment at all. The men were then measured on an "improvement scale" with these stunning results: 44 per cent improved with psychoanalysis, 64 per cent improved with other therapies, and 72 per cent got better with no treatment at all. > More recently, Werner Mendel, professor of psychiatry at the University of Southern California, directed a similar study. Trained psychoanalysts treated the patients in the first group, less highly trained psychologists and psychotherapists treated the second group, and the third group was under the care of employees with no formal training. The improvement ratings showed the following remarkable results: the third group, treated by staff members without formal training in therapy, showed the most improvement, whereas the first group, treated by staff members with the most extensive training in psychotherapy, showed the least improvement. Understandably, Dr. Mendel was startled by the results and repeated the experiment, with the same outcome. Now, I'm not going down this rabbit-hole (I did once and wasted a lot of time!) but there is a lot of evidence that just a bit of attention from another person may be helpful, and affective attention may work wonders. [0] https://www.religion-online.org/article/sin-guilt-and-mental-health-confession-and-restitution-as-means-of-therapy/ https://www.religion-online.org/article/sin-guilt-and-mental...
    - westurner 2y ago
      Which behaviors are reinforced more than a general level of consideration and positive regard? I hadn't heard of this study. I had heard that the case count for psychoanalytic psychotherapy was insufficient to fairly cluster by symptoms as (e.g. hierarchical) features, even. And then Milgram's selection bias. Is all "Talk Therapy" bad then, and what's a good way to actually help; Clean language > Clean language in detail: https://en.wikipedia.org/wiki/Clean_language#Clean_language_in_detail https://en.wikipedia.org/wiki/Clean_language#Clean_language_... : > Clean language offers a template for questions that are as free as possible of the facilitator's suggestions, presuppositions, mind-reading, second guessing, references and metaphors. Clean questions incorporate all or some of the client's specific phrasing and might also include other auditory components of the client's communication such as speed, pitch, tonality. Besides the words of the client, oral sounds (sighs, oo's and ah's) and other nonverbals (e.g. a fist being raised or a line-of-sight) can be replicated or referenced in a question when the facilitator considers they might be of symbolic significance to the client. > [...] "What would you like to have happen? Clean Language Questions : https://cleanlearning.co.uk/blog/discuss/clean-language-questions https://cleanlearning.co.uk/blog/discuss/clean-language-ques... : > The questions containing the verb ‘to be’ help to keep time still and are mostly used for developing individual perceptions: > Questions containing the verb ‘to happen’ generally encourage the client to move time forwards or backwards: > Questions which utilise other verbs are: A prompt: Leadership and Public Speaking: which can utilize Clean Language; and which are necessarily suggestive of direction, course, or sequalae of events?
  - tokai 2y ago
    Its still going, but not in public research institutes. It didn't go out of fashion - it couldn't deliver on the demands for quantitative evidence in modern clinical medicine. That modern psychology now has it's own problems just goes to show how much psychoanalysis is a genre of literature and not much more. Its weird that we are arguing this. The shift is well covered over the last half a decade. Also whats the point of lots of psychoanalytic papers being published? There exists a ton of string theory papers. Theology is a huge field, once the biggest academic discipline. Bullshit exist, so what.
vidarh 2y ago
I have a family member where my whatsapp history is a direct and concrete measure of their improved welfare after starting therapy: Our live conversations have largely been me dealing with the effects of OCD. Once they started therapy, the length of those conversations declined dramatically and rapidly, and while they still have some symptoms they are dealing with them far better. You could argue it's a coincidence, but it'd seem a highly unlikely one given the therapy was specifically to address that OCD, and the techniques they're using to reduce the frequency were taught by the therapist. And of course it is one anecdote. I have no doubt there are lots of people for whom therapy is insufficient or doesn't work, but there are also people for whom you can measure the effects in a lot of other ways than the judgment of therapists themselves.
- coldtea 2y ago
  What's contested is not that some therapist or therapy sessions ever helped people. It's that it's scientific and systematic (and not e.g. arbitrary and subjective, whose efficacy is based on methodology but on the specific patient, the specific therapist, their rapport, and such things). Talking to a friend also helped many a person overcome psychological problems. As did getting a new job, working out, getting laid, and lots of other things. None of those things claim to be scientific fields though.
  - sseagull 2y ago
    > It's that it's scientific and systematic (and not e.g. arbitrary and subjective Care to enlighten us on a better way? We have people who need help right now, not when (or even if) we find some sort of objective test. Just because we can’t measure something objectively doesn’t mean it’s not important or useful (McNamara fallacy). I am a “hard” scientist (physical chemist), and like most (old-ish) scientists I have come to appreciate the “softer” side of life.
    - coldtea 2y ago
      >Care to enlighten us on a better way? We have people who need help right now, not when (or even if) we find some sort of objective test. Doesn't mean they are getting help. Just means we set up a whole cargo cult field from thin air and on thin premises, and make-pretend we help them. Meanwhile, more important structural changes to get them help, are of course ignored, because they are bad for bussiness or inconvenient (like better work-life-balance, less stressful educational/work/healthcare/late life prospects, more cohesive communities, better access to nature, less advertising and rage bait, and anything that doesn't help with the corporate mills grinding on).
benterix 2y ago
I don't believe it's 100% true for all therapies. CBT works exactly as you describe, although it's efficient only for specific problems. There might be other therapies I don't know about which are equally clinically tested as CBT.
dbspin 2y ago
I'm sorry but this is a classic example of experts in one field (assuming CS by virtue of posting on Hacker News) assuming that they know anything worth saying about another field. There actually is a mountain of quantitative outcome research across therapy approaches. It's readily readable in metastudy form on Google Scholar and elsewhere.
- coldtea 2y ago
  >I'm sorry but this is a classic example of experts in one field (assuming CS by virtue of posting on Hacker News) assuming that they know anything worth saying about another field. Or maybe it's just a classic example of a pseudo-field? >There actually is a mountain of quantitative outcome research across therapy approaches "Quantitative outcomes" for non-quantifiable conditions means "numerical statistics on answers in questionaires" and such. >It's readily readable in metastudy form on Google Scholar and elsewhere. Ah, metastudies, that pinnacle of rigour. "We hastily surveyed 200 varying quality, full of methodological errors, non replicating for the most part, primary studies, and the field is totally a success".
  - dbspin 2y ago
    If you can't define a null hypothesis, you can't make a coherent or convincing argument. You're just restating your bias.
dwb 2y ago
What qualifications do you have that might add weight to your implied dismissal of more-or-less an entire field?
- coldtea 2y ago
  Thankfully none collected from within the field.
  - dwb 2y ago
    I rest my case. Cartoonish levels of “hard”-science-nerd arrogance.
    - coldtea 2y ago
      Yeah, or as I call it "pragmatic levels of actual science dismisall of pseudo-sciences". Note how tye very same accusation as yours could be (and was made) for Freudian psychanalysis, homeopathy, and any other bs field.
KingMob 2y ago
> specific clinical results Uh, I have bad news for you about the reproducibility crisis that's also in medicine/biology. It's just like psychology but 100x worse because there's real money at stake.

pratio 2y ago

Therapy isn't pseudoscience but the reproducibility crisis is real. There's also the issue that if you change a therapist, their approach to treating, diagnosing a condition will change. With modern medicine, we have tests and reports and doctor's don't've that much of a leeway on how they treat a condition. We have medical malpractice lawsuits when doctor's go out of line. Like the parent mentioned, the reproducibility crisis didn't change anything, we also can't be sure how many doctors actually took these findings into account. The point I'm trying to make is that it is really difficult to identify bad therapists. It'll take a while before it's reliable enough and that's okay, but therapy gets thrown around as an option like it is.