4 ms·

I think the preying part of therapy is that there's just no defined stop condition. There's no such thing as "healthy" in mental health. You get chemo until you

I think the preying part of therapy is that there's just no defined stop condition. There's no such thing as "healthy" in mental health. You get chemo until you go into remission or you die. You take blood pressure meds until you have a better lifestyle and body composition and don't need them anymore, etc. There's no analogue for "you're healthy now, go away so I can help others", and so therapy goes on forever until the patient stops for whatever reason.

cbsmith 2y ago
> I think the preying part of therapy is that there's just no defined stop condition. There's no defined stop point for physical development either... Top performing athletes still have trainers, and nobody sees that as a problem. If it's mental development though, it must have a stop point?
- detourdog 2y ago
  The stop point is obvious to the individual and the therapist. I'm dealing with someone that prefers to stop rather than actually self-reflection. There is nothing stopping them from exiting therapy. The therapist may be aware that the person is still a basket case but if they are non-violent they are free to roam.
  - cbsmith 2y ago
    Exactly.
  - naasking 2y ago
    > The stop point is obvious to the individual and the therapist. It's not at all. There are plenty of stories of people who realized that therapy was just causing them to ruminate on their problems, and that the therapist was just milking them for years before they wised up and walked away. That's not what I call "obvious".
    - detourdog 2y ago
      I think either the therapist or the patient was not devoted to therapy.
      - naasking 2y ago
        No true Scotsman eh? Classic for a reason!
        detourdog 2y ago
        Considering we are discussing a licensed professional I think your argument is weak. Second I allowed for the failure of the therapist in their duty.
        naasking 2y ago
        The trustworthiness of a license in a field with a poor replication rate and whose best therapy is at best 50% effective is what's weak.
    - nathanasmith 2y ago
      >There are plenty of stories of people who realized that therapy was just causing them to ruminate on their problems This is precisely why I stopped going.
- naasking 2y ago
  What a ridiculous analogy. "Athlete" is a career. Is someone making a career of being in therapy? > If it's mental development though, it must have a stop point? What is being developed, exactly?
  - cbsmith 2y ago
    > What a ridiculous analogy. "Athlete" is a career. The athlete is the extreme example, but there are obviously people who are not career athletes that don't have a defined stop point with employing a trainer (maybe you could say "death" is the stop point). Most everyone who goes to spinning class isn't a career athlete. Some of them are terribly out of shape, and some of those people just want to get in shape. Others may already be in shape, but see the spinning class as a way to either improve or maintain their conditioning. None of this is deemed ridiculous. I'm curious, it's considered the norm to regularly see a doctor or dentist, do you think they're preying on their patients? > What is being developed, exactly? Mental health. There's obviously a more involved answer, but if you don't know it already, it's unlikely I'll be able to educate you with a comment on social media.
    - naasking 2y ago
      > but there are obviously people who are not career athletes that don't have a defined stop point with employing a trainer And many of them are being bilked as well. The fitness industry is notoriously filled with hucksters and scams, and "trainers" rarely have any real training in kinesiology or exercise science. > I'm curious, it's considered the norm to regularly see a doctor or dentist, do you think they're preying on their patients? Once a year for a health checkup. Is that the norm for therapy? > Mental health. There's obviously a more involved answer The more involved answer is that "mental health" is not well-defined, so it's not developing anything. The only therapies that have shown to have any empirical validity, like CBT, train the user in tools to change their own behaviour and thinking, then it's on the user to employ the tools. Does a family doctor call you in once a week and watch you take the pills that address your physical ailment? The best analogy for psychiatric therapy is physical therapy for recovering from an injury or surgery, except physical therapy has a well-defined end condition, which is when you understand how to do the exercises yourself. Then it's on you to do them. This is just not the norm for "mental health" therapy.
- renewiltord 2y ago
  Top performing athletes are better than me at being athletes. Meanwhile, the more therapy someone does, the more miserable they are compared to me. I’m the Usain Bolt of mental health compared to them. Makes me think their trainer is an idiot.
  - cbsmith 2y ago
    > Meanwhile, the more therapy someone does, the more miserable they are compared to me. Is this based on empirical statistical analysis, or are you maybe projecting your perception on to anecdotes? How are you quantifying misery? What are the units? Are there people that are less miserable than you? Do you know how much therapy they've done, or if they've done therapy at all? > I’m the Usain Bolt of mental health compared to them. Makes me think their trainer is an idiot. There's a lot of people that think they're Usain Bolt. Most of them are not.
    - renewiltord 2y ago
      I suppose we’ll see in the next twenty years. I rate my chances and I don’t rate those of the chronically therapized. But hey, let the chips fall where they may.
jodrellblank 2y ago
I sometimes recommend Dr David Burns' Feeling Good podcast[1], and he is big on measuring and testing and stop points. Instead of 'tell me about your mother' his style of Cognitive Behavioural Therapy (CBT) is called TEAMS in which the T stands for Testing, and it involves: - Patient choosing a specific mood problem/feeling they want to work on. - A mood survey, where the patient rates their own level of e.g. anxiety, depression, fear, hopelessness. (e.g. out of 5 or 10). - Therapy session, following his TEAMS CBT structure. Including patient choosing how much fear they'd like to feel (e.g. they want to keep a little bit of fear so they don't endanger themselves, but don't want to be overwhelmed by fear, 5% or 20%, say). - A repeat of the mood survey, where the patient re-assesses themselves to see if anything has improved. There's no units on the measures because it's self-reported, the patient knows if the fear is unchanged, a little less, a lot less, almost gone, completely gone, and that's what matters. That gives them feedback; if there is improvement within a session they know something in the session helped, if several sessions go by with no improvement they know it and can change things up and move away from those unhelpful approaches in future with other patients, and if there is good improvement - patient is self-reporting that they are no longer hopeless about their relationship status, or afraid of social situations, or depressed, to the level they want, then therapy can stop. He's adamant that a single 2hr session is enough to make a significant change in many common mood disorders[2], and this "therapy needs to take 10 years" is a bad pattern and therapists who don't take mood surveys and before and after every session are flying blind. With feedback on every session and decades of experience, he has identified a lot of techniques and ways to use them which actually do help people's moods change. I liken it to the invention of test cases and debuggers (and looking at the output from them). [1] Quick list: https://feelinggood.com/list-of-feeling-good-podcasts/ https://feelinggood.com/list-of-feeling-good-podcasts/ more detailed database: https://feelinggood.com/podcast-database/ https://feelinggood.com/podcast-database/ [2] no, internet cynic, obviously not everything and presumably not whatever it is you have.
- naasking 2y ago
  I agree some therapists are starting to come around on this, but even what you describe is somewhat flawed due to placebo effects, eg. some always feel better from any kind of talk, probably as a result of someone paying attention to their problems. You might be able to overcome this effect by quantitatively tracking this across many sessions to some degree, but I think it's still always the patient that has to walk away, and never the therapist who says, "you're good, go on now".
fatbird 2y ago
I think you're mistaken, at least in a lot of cases. All CBT based therapies I've had have started with a clear discussion about what the problem is, and what the solution looks like in terms of my happiness and mental well-being. In all cases, my therapist has "graduated" me, telling me that they don't think I need to continue (or having me say that I'm comfortable now stopping regular therapy). CBT and its derivatives very strongly attend to individual effectiveness and view therapy that goes on endlessly as a sign that the real problem isn't being addressed, and that no therapy is considered effective unless it ends. Individual therapists might be bad actors, but the field itself is now admirably focussed on finite, positive results.
- naasking 2y ago
  Sounds like a great improvement, but I would hesitate to call it the norm. The therapy industry is booming.

cbsmith 2y ago

> I think the preying part of therapy is that there's just no defined stop condition. There's no defined stop point for physical development either... Top performing athletes still have trainers, and nobody sees that as a problem. If it's mental development though, it must have a stop point?

detourdog 2y ago
The stop point is obvious to the individual and the therapist. I'm dealing with someone that prefers to stop rather than actually self-reflection. There is nothing stopping them from exiting therapy. The therapist may be aware that the person is still a basket case but if they are non-violent they are free to roam.
- cbsmith 2y ago
  Exactly.
- naasking 2y ago
  > The stop point is obvious to the individual and the therapist. It's not at all. There are plenty of stories of people who realized that therapy was just causing them to ruminate on their problems, and that the therapist was just milking them for years before they wised up and walked away. That's not what I call "obvious".
  - detourdog 2y ago
    I think either the therapist or the patient was not devoted to therapy.
    - naasking 2y ago
      No true Scotsman eh? Classic for a reason!
      - detourdog 2y ago
        Considering we are discussing a licensed professional I think your argument is weak. Second I allowed for the failure of the therapist in their duty.
        naasking 2y ago
        The trustworthiness of a license in a field with a poor replication rate and whose best therapy is at best 50% effective is what's weak.
  - nathanasmith 2y ago
    >There are plenty of stories of people who realized that therapy was just causing them to ruminate on their problems This is precisely why I stopped going.
naasking 2y ago
What a ridiculous analogy. "Athlete" is a career. Is someone making a career of being in therapy? > If it's mental development though, it must have a stop point? What is being developed, exactly?
- cbsmith 2y ago
  > What a ridiculous analogy. "Athlete" is a career. The athlete is the extreme example, but there are obviously people who are not career athletes that don't have a defined stop point with employing a trainer (maybe you could say "death" is the stop point). Most everyone who goes to spinning class isn't a career athlete. Some of them are terribly out of shape, and some of those people just want to get in shape. Others may already be in shape, but see the spinning class as a way to either improve or maintain their conditioning. None of this is deemed ridiculous. I'm curious, it's considered the norm to regularly see a doctor or dentist, do you think they're preying on their patients? > What is being developed, exactly? Mental health. There's obviously a more involved answer, but if you don't know it already, it's unlikely I'll be able to educate you with a comment on social media.
  - naasking 2y ago
    > but there are obviously people who are not career athletes that don't have a defined stop point with employing a trainer And many of them are being bilked as well. The fitness industry is notoriously filled with hucksters and scams, and "trainers" rarely have any real training in kinesiology or exercise science. > I'm curious, it's considered the norm to regularly see a doctor or dentist, do you think they're preying on their patients? Once a year for a health checkup. Is that the norm for therapy? > Mental health. There's obviously a more involved answer The more involved answer is that "mental health" is not well-defined, so it's not developing anything. The only therapies that have shown to have any empirical validity, like CBT, train the user in tools to change their own behaviour and thinking, then it's on the user to employ the tools. Does a family doctor call you in once a week and watch you take the pills that address your physical ailment? The best analogy for psychiatric therapy is physical therapy for recovering from an injury or surgery, except physical therapy has a well-defined end condition, which is when you understand how to do the exercises yourself. Then it's on you to do them. This is just not the norm for "mental health" therapy.
renewiltord 2y ago
Top performing athletes are better than me at being athletes. Meanwhile, the more therapy someone does, the more miserable they are compared to me. I’m the Usain Bolt of mental health compared to them. Makes me think their trainer is an idiot.
- cbsmith 2y ago
  > Meanwhile, the more therapy someone does, the more miserable they are compared to me. Is this based on empirical statistical analysis, or are you maybe projecting your perception on to anecdotes? How are you quantifying misery? What are the units? Are there people that are less miserable than you? Do you know how much therapy they've done, or if they've done therapy at all? > I’m the Usain Bolt of mental health compared to them. Makes me think their trainer is an idiot. There's a lot of people that think they're Usain Bolt. Most of them are not.
  - renewiltord 2y ago
    I suppose we’ll see in the next twenty years. I rate my chances and I don’t rate those of the chronically therapized. But hey, let the chips fall where they may.

jodrellblank 2y ago

I sometimes recommend Dr David Burns' Feeling Good podcast[1], and he is big on measuring and testing and stop points. Instead of 'tell me about your mother' his style of Cognitive Behavioural Therapy (CBT) is called TEAMS in which the T stands for Testing, and it involves: - Patient choosing a specific mood problem/feeling they want to work on. - A mood survey, where the patient rates their own level of e.g. anxiety, depression, fear, hopelessness. (e.g. out of 5 or 10). - Therapy session, following his TEAMS CBT structure. Including patient choosing how much fear they'd like to feel (e.g. they want to keep a little bit of fear so they don't endanger themselves, but don't want to be overwhelmed by fear, 5% or 20%, say). - A repeat of the mood survey, where the patient re-assesses themselves to see if anything has improved. There's no units on the measures because it's self-reported, the patient knows if the fear is unchanged, a little less, a lot less, almost gone, completely gone, and that's what matters. That gives them feedback; if there is improvement within a session they know something in the session helped, if several sessions go by with no improvement they know it and can change things up and move away from those unhelpful approaches in future with other patients, and if there is good improvement - patient is self-reporting that they are no longer hopeless about their relationship status, or afraid of social situations, or depressed, to the level they want, then therapy can stop. He's adamant that a single 2hr session is enough to make a significant change in many common mood disorders[2], and this "therapy needs to take 10 years" is a bad pattern and therapists who don't take mood surveys and before and after every session are flying blind. With feedback on every session and decades of experience, he has identified a lot of techniques and ways to use them which actually do help people's moods change. I liken it to the invention of test cases and debuggers (and looking at the output from them). [1] Quick list: https://feelinggood.com/list-of-feeling-good-podcasts/ https://feelinggood.com/list-of-feeling-good-podcasts/ more detailed database: https://feelinggood.com/podcast-database/ https://feelinggood.com/podcast-database/ [2] no, internet cynic, obviously not everything and presumably not whatever it is you have.

naasking 2y ago
I agree some therapists are starting to come around on this, but even what you describe is somewhat flawed due to placebo effects, eg. some always feel better from any kind of talk, probably as a result of someone paying attention to their problems. You might be able to overcome this effect by quantitatively tracking this across many sessions to some degree, but I think it's still always the patient that has to walk away, and never the therapist who says, "you're good, go on now".

fatbird 2y ago

I think you're mistaken, at least in a lot of cases. All CBT based therapies I've had have started with a clear discussion about what the problem is, and what the solution looks like in terms of my happiness and mental well-being. In all cases, my therapist has "graduated" me, telling me that they don't think I need to continue (or having me say that I'm comfortable now stopping regular therapy). CBT and its derivatives very strongly attend to individual effectiveness and view therapy that goes on endlessly as a sign that the real problem isn't being addressed, and that no therapy is considered effective unless it ends. Individual therapists might be bad actors, but the field itself is now admirably focussed on finite, positive results.

naasking 2y ago
Sounds like a great improvement, but I would hesitate to call it the norm. The therapy industry is booming.