
Therapy Experience Associated with Negative Changes in Personality - whitepoplar
http://www.sciencedirect.com/science/article/pii/S0092656616302410
======
civilian
PDF download link: [http://dx.doi.org.sci-
hub.cc/10.1016/j.jrp.2017.02.002](http://dx.doi.org.sci-
hub.cc/10.1016/j.jrp.2017.02.002)

If you're new to scientific papers, the heuristic to use is: Read the
Abstract, Introduction, and the Discussion/Conclusion. Methods & Results are
boring and numbery, and you can dive into those later.

I highly recommend reading the whole General Discussion section. It's four
pages. The main idea is that:

\- There are previous well-controlled studies that show the benefits of
therapy, but

\- When we are simply observing a cohort of people, the people who have some
form of therapy experience a decline in positive indicators and a rise in
negative indicators. (Indicators like self-esteem, depression, etc)

This might be because:

1\. The therapy did help, relatively, but because of the strong force from a
patient's trauma, they were still generally doing poorly. But it could have
been worse.

2\. Because of the broad definition of "therapy experience" and the limited
data in the survey, maybe this is mostly capturing people who only received a
few sessions, and didn't continue long enough to receive the benefits, or in
the case of the US cohort, only received drugs.

3\. Maybe everyday therapists are kinda shitty? The therapists selected for
controlled studies are always up to date with modern techniques. The paper
said it more eloquently:

 _> The third explanation concerns therapists who deliver therapy. Again, in a
controlled intervention, treatment integrity is often one of the highest
priorities of the research protocol. In contrast, implementation of
empirically supported therapy in real-world settings may not happen with as
much structure or rigor._

I think these are all good hypotheses, but the 3rd explanation is pretty
scandalous.

~~~
AnotherHustler
Additionally, the study does not differentiate between therapy types received
- treatment modalities vary in efficacy depending on person and context. For
example, 20 years ago it was known within psychology that "Cognitive Therapy"
had about a 50/50 success rate. However, if you try to apply cognitive therapy
to someone diagnosed with borderline personality disorder - it's not likely to
work ever - and might actually make things worse (Dialectic Behavioural
Therapy is probably the gold standard for this).

As you travel down the road towards being a psych. professional - you tend to
subscribe a school of thought about behavior and personality, and there are a
few to choose from (e.g. people are generally self-directed and will solve
their own problems given the opportunity, or behavioural problems have their
roots in learning - so training is required) - and depending on your opinion
you'll eventually subscribe to a treatment modality that resonates with what
you believe (the extreme version of this is abandoning psychology & switching
to medicine / psychiatry because you believe behavior is simply a
neurochemical process).

Serious personality disorders are very difficult to treat, which brings me to
my next point. The Big-Five factor model used to determine change over time
does not factor diagnosis, so we don't really get a picture of what the cohort
looks like. We know nothing about patient history or reason for seeking
therapy (i.e. have you been evaluated admitted to a psychiatric ward in the
past? have you suffered from substance abuse problems?). And finally, the big
question that would be useful is "what problems caused you to seek therapy?"
Depression vs. hearing voices in one's head vs. got divorced because I like to
drink are all very different issues.

I would like to have seen at least three more measures: reason for treatment,
length of treatment and therapy modality used.

However, I will say that stating that "new research proves that therapy
doesn't work" will get you a click or two ;-)

------
coffeemug
That doesn't surprise me. Anecdotally, everyone I know who is on a "self-
discovery" quest never seems to discover anything or actually get happier.
They tend to stay miserable and keep looking indefinitely. The people I know
who do improve tend to stop looking and start doing (exercise, learning new
things, etc.).

~~~
Alex3917
> The people I know who do improve tend to stop looking and start doing
> (exercise, learning new things, etc.).

Ironically this probably isn't only because doing things brings happiness, but
because more experience means more context, and more context means more
understanding. The only way to gain a better understanding of your life is to
have more types of experiences, sitting there and thinking about it within the
framework of the experiences you've already had generally isn't that useful.

E.g. the best way to understand why a previous relationship didn't work out is
to have more relationships.

~~~
rrradical
I just went through a long period of self reflection that I found very
helpful. It wasn't easy, but there wasn't really another option as I didn't
have the energy to try new things. Now I am doing new things again and it is
of course helpful, but I can't discount the benefit that reflection provided.

------
taurath
So say you successfully make a change to one or more personality traits - I'd
expect self esteem to go down, stress to go up and all the negativity
experienced to happen. Changing personality isn't like putting on prescription
lenses, it's like changing from green to red glasses. Things can become harder
for a long time after a perspective change - most studies I've seen on CBT for
example show it's still good for longer term outcomes.

------
Shank
It's worth noting that in the article, they too express some surprise at their
results:

> The most pressing issue that emerges is why these results run counter to the
> hundreds of more controlled, clinical intervention studies, which largely
> show positive effects of therapy not only on measures of distress and well-
> being, but also personality traits.

In addition, the discussion section states:

> Thus, whereas individuals reported seeing a therapist in our observational
> research, they may not have seen them long enough to induce positive change.
> Further, it could be that some people started therapy because of a traumatic
> life event and actually declined at a less rapid rate than if they had not
> sought therapy.

As always, I think the answer is to wait and see. While they've noticed a
correlation in two studies, it isn't that they've contradicted all of the
prior evidence about therapy. Still, a neat read though.

------
zellyn
Can someone with more insight in this field tell me whether this is the same
as claiming that people who have heart surgery tend to suffer more subsequent
declines in cardiac health compared to those who never needed heart surgery?

~~~
Mizza
It might be more apt to say something like those who opted for an elective
colonic irrigation ended up with higher rates of impacted bowels.

------
laughfactory
I've previously experienced two kinds of therapy: one which emphasized the
"what do you feel, why do you feel like that, what or who caused you to feel
this way", and one which completely disregarded the past, who was to blame,
etc. and which instead focused on what actions I was presently taking, and
what positive outcomes resulted from my actions. Guess which method worked.

Unfortunately, I think a lot of the therapy out there is the first type, which
for me, and most (I suspect), just makes the negative spiral worse. You spend
MORE time thinking about what's wrong with you then you did before (if that
were possible).

The second approach was life changing for me. I learned to let go of the past,
and focus on what I'm doing which works (which, surprise surprise, leads to
more of such behavior). And interestingly enough, the therapy was relatively
short term: something like three months, once a week. And that was almost ten
years, marriage, and three kids ago--and I'm still practicing to good effect
what I learned in that brief time.

So my advice to anyone who will listen who's in therapy or interested in it is
this: seek out a counselor or therapist who focuses on short term therapy
which focuses on present action and positive (desirable to you) outcomes.
Every other approach, IMHO, is a waste of time and money...And may make you
more worse off in the end. These people can be hard to find, but they're worth
their weight in gold.

------
rrggrr
People alone with their negative thoughts do real damage to themselves and
others. Therapy is the only and/or and appropriate resource for many of those
people. Negative attributes from therapy? Without a doubt it says more about
the modalities, and even the therapists than the patients.

~~~
drzaiusapelord
Not to mention, from my own perspective as a therapy goer, a lot of personal
and mental problems stem from a certain lack of social skills or immaturity,
as well as working through trauma or biological mental illness (I have all
three). Yes, you might come back from therapy a lot more assertive and "mean"
than you were before, but its important to note you were maddeningly
depressive and a zombie-like 'yes man/woman' before.

This reminds me a bit of the movie Awakenings, where one of the patients who
came out of his coma was upsetting his mother. His mother was so used to him
being this passive and lovable manchild that she couldn't handle him when he
became assertive, spoke back to her, and wanted to spend time with young
ladies and not with his mother. She never saw him go through a proper teenage
rebellion stage and he wanted to live life immediately and really had no time
for mother anymore because he just wanted to pursue his crush. To his mother,
the therapy was a failure because she was no longer happy with him.

I also think there's an element of becoming jaded as one gets older,
generally. The more experience you have with people, life, etc the more you
realize we really are not good creatures and a lot of the wonderful optimism
we've been taught be in a spiritual, social, or familial environment are often
wrong, if not entirely false and people are just simply predictable animals
fighting for resources. Therapy and other methods of self-discovery often lead
to these self-discoveries and can really lead to a certain level of
'depressive realism.'

I read somewhere the happiest people are the ultra-religious and cult members.
Everything is explained and everything is simple to them as a singular and
unquestionable authority gives them all the answers. Therapy in the western
tradition is pretty much the opposite of that. I guess you have to ask
yourself if you want to be delusional and happy or realistic and perhaps have
a good chance at being content with life and with occasional happiness and
accepting of negative situations when they come.

I suspect most people's idea of a mentally healthy person don't fit in with
what its actually like to be mentally healthy. Its not all smiles and
laughter. Its also toughness and resiliency and the ability to say 'no' to
you. If your friend came back from therapy like this, you'd think it was a
failure, but I suspect he feels much more validated in life and much more
autonomous.

------
cavanasm
Is there a non-paywalled version of this? The abstract seems painfully vague
to me, or is there some domain specific explanation for desirable vs
undesirable personality traits? Are they literally saying that therapy makes
whatever people are in therapy for worse?

~~~
DashRattlesnake
Have you tried Sci-Hub?

[https://en.wikipedia.org/wiki/Sci-Hub](https://en.wikipedia.org/wiki/Sci-Hub)

------
KKKKkkkk1
A few years back, there was a prestigious psychology journal that published a
paper about extrasensory perception. I'm wondering whether the extrasensory-
psychology journals are distinct from the clinical-psychology journals, or do
they have the same levels of scientific rigor?

------
curuinor
Causal statement in the headline. You might think only correlational statement
on paper, and this is somewhat true but it is a controlled ecologicalish
study.

no random assignment.

bad temporal proximity of data gathering on personality.

methodological poking about at the badness of controlled vs observational
studies. basically study recruitment as a selection effect.

~~~
maxander
They do perform a statistical analysis ("propensity score matching") to try to
control for off-target correlations, but its true that the entire strength of
the paper revolves around this having been done correctly and it being
sufficient. Given the fact that improperly controlling for confounding factors
could entirely account for their data (people whose personality traits are
deteriorating are likely to have some awareness of this, and _therefore to
seek therapy_ ) you would think that an account of this procedure would be
front-in-center of their argument- but no, all details of that step are
relegated to supplemental data for some reason.

It's also worth noting that data collection was entirely done through surveys;
so, another explanation could be that therapy simply made people more aware of
pre-existing personality deficits, that they were then able to more accurately
report.

And further, even if the results are valid, it doesn't invalidate the benefits
of therapy; most therapy methods are built around _helping the patient._ Its
possible that therapy improves the _subjective quality_ of the patient's life
at the expense of some external qualities (or pretense thereof.)

~~~
civilian
_> Its possible that therapy improves the subjective quality of the patient's
life at the expense of some external qualities (or pretense thereof.)_

That's not the case-- they were measuring for subjective quality, and it was
subjective quality that declined. I posted the PDF of the paper in my top-
level comment, but the Psychological measurements they were looking at in the
German cohort were self-esteem, life satisfaction, and depression. The US
cohort was measured for self-esteem, chronic stressors, and depression.

------
temp246810
It's a shame that stuff like this makes it to the top of HN.

Not because the content itself is good or bad, but because it is precisely
someone struggling with this stuff who has a high likelihood of walking away
from the article with the wrong message.

I understand that we're all responsible for our decisions etc., but this is
really out of our wheel house and hopefully the people in need of therapy
consult with professionals before acting on anything that bubbles up here.

~~~
civilian
_rolls eyes_ people have got to have a little agency, and we can't censor
things like this just because we're worried about them taking it the wrong
way.

You know what would help get more people who need help into therapy? If
therapy clinics allowed you to schedule a first session without having to call
them! If you're suffering from anxiety and depression, then the thought of
some receptionist asking you why you want to schedule an appointment is pretty
terrifying.

~~~
wpietri
People who are in need of help may not have much agency to spare. E.g., The
notion of Spoon Theory comes from someone with lupus, but you'll often see
people with mental illness discussing it online:
[https://butyoudontlooksick.com/articles/written-by-
christine...](https://butyoudontlooksick.com/articles/written-by-
christine/the-spoon-theory/)

And I think there are things between censorship and featuring anything that
sounds sensational. One of the primary criticisms of mainstream science
journalism is that it will take one recent study and focus on it excessively,
giving readers a false impression. The same concern on Wikipedia is known as
"undue weight":
[https://en.wikipedia.org/wiki/Wikipedia:Neutral_point_of_vie...](https://en.wikipedia.org/wiki/Wikipedia:Neutral_point_of_view#Due_and_undue_weight)

I don't think HN is above criticism on this.

------
kazinator
Scratching scabs positively correlates with increased bleeding and healing
time.

------
programminggeek
Focusing inward on problems and negativity is a great way to increase the
feelings of negativity and hopelessness.

Instead, ignoring the how and why of a crap situation and simply working to
improve your situation will improve your outlook on it.

Do stuff to make life better and you will feel better as if by magic. Just
ignore the problems until they manage to disappear on their own.

One step in front of the other.

1 > 0.

~~~
pekk
People with real problems like major clinical depression, severe anxiety that
prevents them from leaving the house, schizophrenia, etc. aren't going to be
suddenly cured now that you have told them "1 > 0" and all they have to do is
put "one step in front of the other."

"Just ignore the problems" doesn't work for people who have problems which
are, you know, actually serious.

------
benevol
On a related note, educate yourself _fully_ about LSD. Then make your _fully
educated_ decision on whether to go ahead or not.

~~~
Kenji
One is never fully educated until after the fact ;)

~~~
klibertp
That might have been the point.

