10 ms·

I often wonder if therapy is "over prescribed" these days. I've struggled with various problems and therapy has seemingly always made it worse. We would "expl

by robswc 2y ago

I often wonder if therapy is "over prescribed" these days. I've struggled with various problems and therapy has seemingly always made it worse. We would "explore" things which caused me to dwell and dedicate so much brain power to "untangling" ideas. Eventually, I would always be "cured" after some relentless distractions and not the therapy. I truly believe the therapists wanted to help, and our progress felt real... but looking back, it was probably worse than doing noting. I bring this up because I believe some people need therapy, but many people are encouraged to seek it out for problems that could be overcome with other methods, causing a "therapist shortage." This has downstream effects, like the one posted here.

DevX101 2y ago
Agreed. There's a lot of therapy that used to be addressed via talking an issue out w/ friends/partners/family/church, or other built in cultural institutions. There's a lot of therapy that our in person social networks should be doing (and we should be giving). As we become more lonely and our social institutions fall, it opens the door for the therapization of our modern culture, which seems like a bandaid on a deeper problem. This isn't to admonish therapy, but ideally it should probably be for more severe issues.
borroka 2y ago
I will go even further than that. Talk therapy is the scam of the 2000s. The trickle that brought what we call therapeutic language into everyday life, the constant references to the narcissism of a partner who, if we are honest, had the great fault of just not wanting us anymore, the masochistic lingering over traumas that are nothing more than everyday life, the safe spaces, the escape from responsibilities that should be ours but we have been taught to assign to society, has had disastrous effects on human relations and also on political discourse. On top of that, I have rarely, if ever, found people participating in talk therapy getting better. If it were a pill, no honest doctor would prescribe it.
- sneak 2y ago
  Cognitive behavioral therapy, the most common type of “talk therapy” these days, shows effectiveness on par with medications in a broad range of studies with good methodology. It is important to remember that anecdotes are not data.
  - borroka 2y ago
    What kind of medications are we talking about, for what "issue" (suicidal thoughts or "my parents are disappointed because I did not go to college and I am feeling worthless") and what is the effectiveness, especially long-term, of either medication or talk therapy? I certainly present anecdotes, and I also live in this world and I notice and I observe and I evaluate. The comment I am responding to does even less. The second scam is, of course, couples counseling. I have sporadically watched Showtime's “Couples Therapy,” and I know several people who have gone to a couples therapist. The cost of a 50-minute session with the therapist presented on the show seems to be $700. After watching parts of the program, I can give my prescription to all the couples featured, free of charge: You need to break up and find someone else. It may be a collection of anecdotes, but I have yet to see a couple “fall in love again” or “settle their differences” after expensive couples counseling sessions. It's time to move on.
  - Veen 2y ago
    Does that demonstrate that therapy is effective or that medications are ineffective?
    - hirvi74 2y ago
      Not the GP, but I'll comment about ADHD, since that is what I have relevantly read research about. For ADHD, it appears that therapy < medication < therapy + medication. When compared head-to-head, therapy is almost as useful as medication, but the issue with therapy is that once the patient stops attending, the benefits tend to diminish rapidly. However, therapy tends to have less side-effects and less stigma. According to some research, medication efficacy also tends to diminish overtime as well. For other conditions, I cannot tell you. I feel like it would be too large of a brush to try and paint with. I could see conditions like personality disorders not benefiting from medication as much as therapy. Conditions like schizophrenia might not truly benefit from either. For conditions like depression and anxiety, I think the medications are efficacious if not perhaps less so than therapy, but do not quote me on this one.
- robswc 2y ago
  Mostly agree with this. In my heart of hearts I truly believe many problems are best left to be abstractions and not "explored." When you explore your problems, you dwell on them and when you dwell on them, you're often not in a good place. It is all anecdotal of course but like you, I notice that my friends and family that constantly go to therapy never seem to get better... and often times worse. I don't think its a case of correlation either, I think they've just made a mountain out of molehill. Now, I do want to say there are _many_ people that absolutely need therapy. I think if you just can't function, you need professional help. That shouldn't be discouraged.
  - lukas099 2y ago
    > my friends and family that constantly go to therapy never seem to get better Isn’t this true for any medical treatment?
    - robswc 2y ago
      I would hope not. I'm still "young" so every visit to a Dr, I've come out with a solution. In any case, I've gone to therapy and it feels like you're making progress (and perhaps I was) but never fixed the problem.
      - lukas099 2y ago
        Exactly. If you are cured you stop doing the treatment. If you are not cured but only somewhat better, you continue it.
kylehotchkiss 2y ago
I’m thinking aloud with you here and not dissuading anybody from taking care of their mental health but wow people really need to learn long term coping techniques. The amount of times I see the word “gaslighting” used to describe everyday interactions has really made the word meaningless in sincerely emotionally abusive situations. Tiktok brain telling everybody that they are screwed together wrong really should be addressed at a policy level.
- robswc 2y ago
  I've noticed this too. Like you, I hate expressing the idea that therapy is "over prescribed", lest someone with real issues put off not going... but man, people over complicate things. Knew someone that went to therapy b/c they constantly thought the world would end any second. Why? Because they kept going on reddit/the internet where every top comment is "the world will end soon." They would talk about their "progress" and all sorts of techniques. Their life seemingly revolved around their new problem to the point you didn't want to hang out with them very long because it would come back to their issues. IMO, the "cure" to this problem is talking a long walk in a park or downtown and get the hell off the internet. Out of curiosity, I just checked and they're still posting... latest posts are about monkeypox and how it will kill hundreds of thousands... sad to see.
  - kylehotchkiss 2y ago
    The world ending would be less treacherous than living each day with the fear of it. Yeah, the cure is just to live in the moment. This is a coping technique. Kids need to be taught this stuff in school.
    - robswc 2y ago
      Yep! It just wasn't healthy at all. I hate the saying "touch grass" but damn if it actually wasn't the fix for this person. As a friend, I wish I could drag them outside and say we're just gonna sit here and people watch. They visit that r/news subreddit and find the worst articles about conflicts, disease and disaster... its like dude just close the laptop! Frustrates me. You do not need to "identify and label triggering content" you need to get out!
zeroCalories 2y ago
I don't think the problem is that people can't be helped, I think the problem is that most therapists are bad at their job. I would not meet with anyone that has not gotten a PhD equivalent or gone to med school at a reputable place.
- robswc 2y ago
  I can agree with this. Just a quick anecdote. One of my problems was public speaking. This was in HS so my parents and teachers encouraged therapy. Unfortunately, this now meant dwelling on my fear of public speaking 3 times a week. We went so "deep" with why I was afraid but tbh it was probably best to keep it as simple as "I'm afraid to mess up" I was "cured" of this fear by a damn video game. It was coming out the day of my presentation and 90% of my brain was focused on the anticipation of the game, only 10% left to worry about the public speaking. I got up, did the presentation on autopilot and then realized "oh, this isn't the worst thing ever" and never had a problem after. Sure, I get nervous but before I would actually throw up on days I knew I had to speak so... I consider it cured :) My therapist was a great and qualified person... but I think I would have never made any true progress... just dwell on and dissected my fear into adulthood.
- harimau777 2y ago
  For what it's worth, I have a family member who ran a non-profit mental health clinic. According to them, studies have found that advanced degrees have little impact on outcomes. From what I recall, he argued studies showed that the key elements for a successful therapist where following some sort of framework/plan (e.g. cognitive therapy, behavioral therapy, Jungian therapy, etc.) and to be contentious (keep records of each session, come into each session with a plan, etc.).
  - nothercastle 2y ago
    It’s not the degree that matters, it’s just that most people have no way to screen for properly trained practitioners of one of the above plans. A top school will be more likely to have trained the students in these plans correctly by experienced trainers
harimau777 2y ago
I suspect that the opposite may be true: That everyone needs talk therapy and this was traditionally provided by pastors, village wise men, extended family co-habitation, etc. Like many things in life, as our society has become more complicated and specialized, clinical social workers have become the specialists who perform that role for many people in society.
- robswc 2y ago
  I could agree with this. I believe there is a benefit in not having "on-demand" access to a therapist and boundaries with the people you talk with.
gruez 2y ago
>I often wonder if therapy is "over prescribed" these days. Relevant: "Bad Therapy: Why the Kids Aren't Growing Up" https://www.amazon.com/Bad-Therapy-Kids-Arent-Growing-ebook/dp/B0CBYHTV2D/ https://www.amazon.com/Bad-Therapy-Kids-Arent-Growing-ebook/...
- pas 2y ago
  ̶c̶a̶n̶ ̶y̶o̶u̶ ̶p̶l̶e̶a̶s̶e̶ ̶p̶r̶o̶v̶i̶d̶e̶ ̶a̶ ̶t̶l̶;̶d̶r̶?̶ ̶w̶h̶a̶t̶'̶s̶ ̶t̶h̶e̶ ̶m̶a̶i̶n̶ ̶a̶r̶g̶u̶m̶e̶n̶t̶,̶ ̶w̶h̶a̶t̶ ̶d̶a̶t̶a̶ ̶i̶s̶ ̶i̶t̶ ̶b̶a̶s̶e̶d̶ ̶o̶n̶?̶ ... okay, I didn't want to be that lazy, so looked up the author. (Her name is interestingly not on the cover :o) Abigail Shrier, hm. okay, at least there's a wikipedia page about her. she seems to be a layman when it comes to psychology/psychiatry. and her 2018 book about "Transgender Craze" ... uh, okay. ... https://thingofthings.substack.com/p/bad-therapy-review-fifties-dad-mental https://thingofthings.substack.com/p/bad-therapy-review-fift... """ Much of Shrier’s book is devoted to critiquing Internet Mental Health Culture, [...] I broadly agree with her critiques. [Her] preferred alternative to Internet Mental Health Culture is what you might call Fifties Dad Mindset. [...] Shrier explicitly says that the right response to “minor cutting” is to ignore it. """ Amazing book.
deleted 2y ago
[deleted]
matrix87 2y ago
simple, some people just make a religion out of it. it's a way of life for them. the same way some people obsess over the bible for some people, it's about finding solutions to specific problems, the scope is well defined, nothing wrong here for others, it's this monolithic worldview that asserts itself as an authority on problems and solutions

by robswc 2y ago

DevX101 2y ago

Agreed. There's a lot of therapy that used to be addressed via talking an issue out w/ friends/partners/family/church, or other built in cultural institutions. There's a lot of therapy that our in person social networks should be doing (and we should be giving). As we become more lonely and our social institutions fall, it opens the door for the therapization of our modern culture, which seems like a bandaid on a deeper problem. This isn't to admonish therapy, but ideally it should probably be for more severe issues.

borroka 2y ago

I will go even further than that. Talk therapy is the scam of the 2000s. The trickle that brought what we call therapeutic language into everyday life, the constant references to the narcissism of a partner who, if we are honest, had the great fault of just not wanting us anymore, the masochistic lingering over traumas that are nothing more than everyday life, the safe spaces, the escape from responsibilities that should be ours but we have been taught to assign to society, has had disastrous effects on human relations and also on political discourse. On top of that, I have rarely, if ever, found people participating in talk therapy getting better. If it were a pill, no honest doctor would prescribe it.

sneak 2y ago
Cognitive behavioral therapy, the most common type of “talk therapy” these days, shows effectiveness on par with medications in a broad range of studies with good methodology. It is important to remember that anecdotes are not data.
- borroka 2y ago
  What kind of medications are we talking about, for what "issue" (suicidal thoughts or "my parents are disappointed because I did not go to college and I am feeling worthless") and what is the effectiveness, especially long-term, of either medication or talk therapy? I certainly present anecdotes, and I also live in this world and I notice and I observe and I evaluate. The comment I am responding to does even less. The second scam is, of course, couples counseling. I have sporadically watched Showtime's “Couples Therapy,” and I know several people who have gone to a couples therapist. The cost of a 50-minute session with the therapist presented on the show seems to be $700. After watching parts of the program, I can give my prescription to all the couples featured, free of charge: You need to break up and find someone else. It may be a collection of anecdotes, but I have yet to see a couple “fall in love again” or “settle their differences” after expensive couples counseling sessions. It's time to move on.
- Veen 2y ago
  Does that demonstrate that therapy is effective or that medications are ineffective?
  - hirvi74 2y ago
    Not the GP, but I'll comment about ADHD, since that is what I have relevantly read research about. For ADHD, it appears that therapy < medication < therapy + medication. When compared head-to-head, therapy is almost as useful as medication, but the issue with therapy is that once the patient stops attending, the benefits tend to diminish rapidly. However, therapy tends to have less side-effects and less stigma. According to some research, medication efficacy also tends to diminish overtime as well. For other conditions, I cannot tell you. I feel like it would be too large of a brush to try and paint with. I could see conditions like personality disorders not benefiting from medication as much as therapy. Conditions like schizophrenia might not truly benefit from either. For conditions like depression and anxiety, I think the medications are efficacious if not perhaps less so than therapy, but do not quote me on this one.
robswc 2y ago
Mostly agree with this. In my heart of hearts I truly believe many problems are best left to be abstractions and not "explored." When you explore your problems, you dwell on them and when you dwell on them, you're often not in a good place. It is all anecdotal of course but like you, I notice that my friends and family that constantly go to therapy never seem to get better... and often times worse. I don't think its a case of correlation either, I think they've just made a mountain out of molehill. Now, I do want to say there are _many_ people that absolutely need therapy. I think if you just can't function, you need professional help. That shouldn't be discouraged.
- lukas099 2y ago
  > my friends and family that constantly go to therapy never seem to get better Isn’t this true for any medical treatment?
  - robswc 2y ago
    I would hope not. I'm still "young" so every visit to a Dr, I've come out with a solution. In any case, I've gone to therapy and it feels like you're making progress (and perhaps I was) but never fixed the problem.
    - lukas099 2y ago
      Exactly. If you are cured you stop doing the treatment. If you are not cured but only somewhat better, you continue it.

kylehotchkiss 2y ago

I’m thinking aloud with you here and not dissuading anybody from taking care of their mental health but wow people really need to learn long term coping techniques. The amount of times I see the word “gaslighting” used to describe everyday interactions has really made the word meaningless in sincerely emotionally abusive situations. Tiktok brain telling everybody that they are screwed together wrong really should be addressed at a policy level.

robswc 2y ago
I've noticed this too. Like you, I hate expressing the idea that therapy is "over prescribed", lest someone with real issues put off not going... but man, people over complicate things. Knew someone that went to therapy b/c they constantly thought the world would end any second. Why? Because they kept going on reddit/the internet where every top comment is "the world will end soon." They would talk about their "progress" and all sorts of techniques. Their life seemingly revolved around their new problem to the point you didn't want to hang out with them very long because it would come back to their issues. IMO, the "cure" to this problem is talking a long walk in a park or downtown and get the hell off the internet. Out of curiosity, I just checked and they're still posting... latest posts are about monkeypox and how it will kill hundreds of thousands... sad to see.
- kylehotchkiss 2y ago
  The world ending would be less treacherous than living each day with the fear of it. Yeah, the cure is just to live in the moment. This is a coping technique. Kids need to be taught this stuff in school.
  - robswc 2y ago
    Yep! It just wasn't healthy at all. I hate the saying "touch grass" but damn if it actually wasn't the fix for this person. As a friend, I wish I could drag them outside and say we're just gonna sit here and people watch. They visit that r/news subreddit and find the worst articles about conflicts, disease and disaster... its like dude just close the laptop! Frustrates me. You do not need to "identify and label triggering content" you need to get out!

zeroCalories 2y ago

I don't think the problem is that people can't be helped, I think the problem is that most therapists are bad at their job. I would not meet with anyone that has not gotten a PhD equivalent or gone to med school at a reputable place.

robswc 2y ago
I can agree with this. Just a quick anecdote. One of my problems was public speaking. This was in HS so my parents and teachers encouraged therapy. Unfortunately, this now meant dwelling on my fear of public speaking 3 times a week. We went so "deep" with why I was afraid but tbh it was probably best to keep it as simple as "I'm afraid to mess up" I was "cured" of this fear by a damn video game. It was coming out the day of my presentation and 90% of my brain was focused on the anticipation of the game, only 10% left to worry about the public speaking. I got up, did the presentation on autopilot and then realized "oh, this isn't the worst thing ever" and never had a problem after. Sure, I get nervous but before I would actually throw up on days I knew I had to speak so... I consider it cured :) My therapist was a great and qualified person... but I think I would have never made any true progress... just dwell on and dissected my fear into adulthood.
harimau777 2y ago
For what it's worth, I have a family member who ran a non-profit mental health clinic. According to them, studies have found that advanced degrees have little impact on outcomes. From what I recall, he argued studies showed that the key elements for a successful therapist where following some sort of framework/plan (e.g. cognitive therapy, behavioral therapy, Jungian therapy, etc.) and to be contentious (keep records of each session, come into each session with a plan, etc.).
- nothercastle 2y ago
  It’s not the degree that matters, it’s just that most people have no way to screen for properly trained practitioners of one of the above plans. A top school will be more likely to have trained the students in these plans correctly by experienced trainers

harimau777 2y ago

I suspect that the opposite may be true: That everyone needs talk therapy and this was traditionally provided by pastors, village wise men, extended family co-habitation, etc. Like many things in life, as our society has become more complicated and specialized, clinical social workers have become the specialists who perform that role for many people in society.

robswc 2y ago
I could agree with this. I believe there is a benefit in not having "on-demand" access to a therapist and boundaries with the people you talk with.

gruez 2y ago

>I often wonder if therapy is "over prescribed" these days. Relevant: "Bad Therapy: Why the Kids Aren't Growing Up" https://www.amazon.com/Bad-Therapy-Kids-Arent-Growing-ebook/dp/B0CBYHTV2D/ https://www.amazon.com/Bad-Therapy-Kids-Arent-Growing-ebook/...

pas 2y ago
̶c̶a̶n̶ ̶y̶o̶u̶ ̶p̶l̶e̶a̶s̶e̶ ̶p̶r̶o̶v̶i̶d̶e̶ ̶a̶ ̶t̶l̶;̶d̶r̶?̶ ̶w̶h̶a̶t̶'̶s̶ ̶t̶h̶e̶ ̶m̶a̶i̶n̶ ̶a̶r̶g̶u̶m̶e̶n̶t̶,̶ ̶w̶h̶a̶t̶ ̶d̶a̶t̶a̶ ̶i̶s̶ ̶i̶t̶ ̶b̶a̶s̶e̶d̶ ̶o̶n̶?̶ ... okay, I didn't want to be that lazy, so looked up the author. (Her name is interestingly not on the cover :o) Abigail Shrier, hm. okay, at least there's a wikipedia page about her. she seems to be a layman when it comes to psychology/psychiatry. and her 2018 book about "Transgender Craze" ... uh, okay. ... https://thingofthings.substack.com/p/bad-therapy-review-fifties-dad-mental https://thingofthings.substack.com/p/bad-therapy-review-fift... """ Much of Shrier’s book is devoted to critiquing Internet Mental Health Culture, [...] I broadly agree with her critiques. [Her] preferred alternative to Internet Mental Health Culture is what you might call Fifties Dad Mindset. [...] Shrier explicitly says that the right response to “minor cutting” is to ignore it. """ Amazing book.

deleted 2y ago

[deleted]

matrix87 2y ago

simple, some people just make a religion out of it. it's a way of life for them. the same way some people obsess over the bible for some people, it's about finding solutions to specific problems, the scope is well defined, nothing wrong here for others, it's this monolithic worldview that asserts itself as an authority on problems and solutions