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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

by vidarh 3y 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 3y 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 3y 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 3y 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).
- Delk 3y ago
  I think it's well known -- and supported by evidence -- that personality, chemistry and rapport with the therapist matter more than the specific kind of therapy. (With some exceptions; for example, cognitive-behavioural therapy is specifically better suited for OCD than other modalities such as psychodynamic therapy are, while CBT alone probably isn't a good fit for severe trauma. AFAIK these are backed by evidence.) So the specific theoretical frameworks aren't really scientific, at least for the most part. But you can do research on stuff such as whether outcomes are on the average better than without therapy, or whether modality or individual therapists matter more. Of course the evidence is largely still from the questionnaires, with all of their problems, but the questionnaires aren't necessarily administered by the people giving the therapy so it may not be as biased as you might think.
- vidarh 3y ago
  It's no more scientific to reject evidence only because it is subjective. For a whole lot of psychological conditions that do not get to the extremes the only reasonable assessment we can do is whether the patient feels there is a problem, or exhibit indicators of distress in relation to the problem. Are you washing your hands so much it is OCD and a problem, or is it just a preference? At the margins - if you e.g. do it so much your hurt yourself - it becomes possible to argue it is objective, but for most people the answer purely comes down to whether or not it is subjectively a problem to them. That does not mean we can not systematically measure whether people report an improvement under varying conditions and using varying methods. It doesn't really matter if it is subjective - when the problem is that the patient feels there is a problem, then if the patient no longer reports feeling a problem, then unless you're prepared to assume that they are all in denial or lying, that is evidence of improvement even if it does not raise to the standard of evidence we would prefer. It would be unreasonable to overstate what that means, but equally unreasonable to pretend it provides no signal in the absence of higher standard evidence unless you can identify specific problems (lack of ability to reproduce would be one).

by vidarh 3y ago

coldtea 3y 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 3y 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 3y 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).
Delk 3y ago
I think it's well known -- and supported by evidence -- that personality, chemistry and rapport with the therapist matter more than the specific kind of therapy. (With some exceptions; for example, cognitive-behavioural therapy is specifically better suited for OCD than other modalities such as psychodynamic therapy are, while CBT alone probably isn't a good fit for severe trauma. AFAIK these are backed by evidence.) So the specific theoretical frameworks aren't really scientific, at least for the most part. But you can do research on stuff such as whether outcomes are on the average better than without therapy, or whether modality or individual therapists matter more. Of course the evidence is largely still from the questionnaires, with all of their problems, but the questionnaires aren't necessarily administered by the people giving the therapy so it may not be as biased as you might think.
vidarh 3y ago
It's no more scientific to reject evidence only because it is subjective. For a whole lot of psychological conditions that do not get to the extremes the only reasonable assessment we can do is whether the patient feels there is a problem, or exhibit indicators of distress in relation to the problem. Are you washing your hands so much it is OCD and a problem, or is it just a preference? At the margins - if you e.g. do it so much your hurt yourself - it becomes possible to argue it is objective, but for most people the answer purely comes down to whether or not it is subjectively a problem to them. That does not mean we can not systematically measure whether people report an improvement under varying conditions and using varying methods. It doesn't really matter if it is subjective - when the problem is that the patient feels there is a problem, then if the patient no longer reports feeling a problem, then unless you're prepared to assume that they are all in denial or lying, that is evidence of improvement even if it does not raise to the standard of evidence we would prefer. It would be unreasonable to overstate what that means, but equally unreasonable to pretend it provides no signal in the absence of higher standard evidence unless you can identify specific problems (lack of ability to reproduce would be one).