
Book Review: All Therapy Books - tomerv
https://slatestarcodex.com/2019/11/20/book-review-all-therapy-books/
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jackpirate
Hmmm... I'm pretty skeptical of the premise that "All therapy books start with
a claim that their form of therapy will change everything."

My wife practices Cognitive Behavioral Therapy (CBT), and the foundation of
her approach and all CBT books on her bookshelf is that CBT in fact doesn't
change anything at all. You will still have symptoms (depression, anxiety,
etc.) after CBT, but the goal of CBT is to help you manage those symptoms and
live a meaningful life despite those symptoms. It's reasonable to doubt that
such an approach can work, but Scott's article entirely misses that this
approach can even exist. I suspect that this is a latent bias due to his
psychiatrist training. (Psychiatrists are trained to use medicine to
reduce/eliminate symptoms, and that is their primary measure of success;
psychologists use therapy, and the reduction/elimination of symptoms is not
necessarily their primary measure of success.)

I just did a quick search on amazon for CBT books, however, and found that
most results are things like "CBT for Dummies" and "Teach yourself CBT in 7
weeks". These are not books for doctors, but books for laymen that are merely
self-help books with a veneer of science/therapy to help the book sell. Who
knows what sort of crap is in these books.

~~~
jrsdav
For those interested in learning more about CBT, "Feeling Good, The New Mood
Therapy" by David Burns is probably the most recommended book out there.
[https://www.amazon.com/Feeling-Good-New-Mood-
Therapy/dp/0380...](https://www.amazon.com/Feeling-Good-New-Mood-
Therapy/dp/0380810336)

There is also a handy CBT app called Quirk that I'd also recommend checking
out [https://www.quirk.fyi/](https://www.quirk.fyi/)

~~~
OscarCunningham
Claim that their form of therapy will change everything:

>The good news is that anxiety, guilt, pessimism, procrastination, low self-
esteem, and other "black holes" of depression can be cured without drugs. In
Feeling Good, eminent psychiatrist, David D. Burns, M.D., outlines the
remarkable, scientifically proven techniques that will immediately lift your
spirits and help you develop a positive outlook on life.

~~~
Rerarom
Ok, this is a premier example of Poe's Law

------
dkarl
_Maybe placebo effect is falling – when people viewed it as an astounding
miracle therapy, it got astounding miracle results, but now that it’s lost its
luster nobody takes it seriously anymore._

I don't think "placebo effect" is an adequate term when the benefit from a
therapy derives from the work patients put in. It's more like dieting than
like a drug. Faith in the program helps people invest the required work and
persevere through difficulties and setbacks. The impulse to give up, to take a
break, to skip the work today, this impulse preys on doubt. In this dynamic,
the differences in inherent effectiveness between one method and another can
be dwarfed by the power of one treatment having superior marketing and
inspiring people to work harder, persist through greater discomfort, and
eventually have a greater likelihood of achieving results — which will of
course be credited to the theoretical ideas underpinning the therapy instead
of the marketing.

~~~
theptip
What you describe could well be the explanation, but it's not the same
mechanism that Alexander is suggesting.

You're suggesting the therapy has a dose-response, and as perception of the
therapy changes, patients are motivated less and so they get smaller doses.

What Alexander is suggesting there is that for a given level of work that a
patient put in (i.e. for a constant dose), the placebo effect has been
reducing due to a "miracle effect" halo that is fading over time.

I.e. he is explicitly talking about just the placebo effect here.

------
FailMore
My own experience with CBT is that the diagnosis of the correct anxiety is the
biggest weakness. Too often we listen to our thoughts in our minds too
directly (e.g. "I'm not good enough") instead of understanding that the
current anxiety has a function, and that is to protect us from what we are
really scared about (it is useful for me to feel like I'm not good enough
because it stops me from standing up for myself / risking a conflict with
others). When I started to apply standard CBT techniques (face your fear) to
the deeper anxiety, I found the surface anxieties vanished (i.e. practiced
having and surviving conflicts got rid of "I'm not good enough" feelings).

Diagnosis of the deep anxiety is probably the biggest challenge. On a side
note I found my dreams were very good at helping me find them by presenting
situations which encouraged non anxious behaviour, which contrast to the
anxious behaviour I would take in the dream - this disparity between what the
situation demanded and how I behaved would highlight the deeper anxiety. I got
very into the subject and wrote a paper on it:
[https://psyarxiv.com/k6trz](https://psyarxiv.com/k6trz), which was discussed
in some depth on HN:
[https://news.ycombinator.com/item?id=19143590](https://news.ycombinator.com/item?id=19143590)

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carapace
There's a school of therapy/psychology that has a rigourous epistemological
basis and gets repeatable results. (I.e. an algorithm for eliminating phobias
that works quickly and reliably with durable change.) This school gets panned
for not being scientific, and I have to admit that that's not undeserved,
however, as I said, the underlying conceptual structure is solid and the
results are repeatable. I myself was cured of a deep and lifelong depression
in a single session of hypnosis by one of the co-founders of this school. So
not only can I vouch for its conceptual integrity, I can also vouch for its
dramatic efficacy. (This isn't "my cousin", or "some guy I heard about", it
was _me_. I lived the anecdote.)

FWIW, some books. "Structure of Magic" I & II are the first two books and are
a good place to start from to see the origins of the latter work. TRANCE-
Formations is a rich text on theraputic hypnosis. And then there's the Core
Transformation Process, an algorithm for profound spiritual growth.

[https://www.goodreads.com/book/show/964154.The_Structure_of_...](https://www.goodreads.com/book/show/964154.The_Structure_of_Magic_I)

[https://www.goodreads.com/book/show/821993.The_Structure_of_...](https://www.goodreads.com/book/show/821993.The_Structure_of_Magic_II)

[https://www.goodreads.com/book/show/956297.Trance_Formations](https://www.goodreads.com/book/show/956297.Trance_Formations)

[https://www.goodreads.com/book/show/369813.Core_Transformati...](https://www.goodreads.com/book/show/369813.Core_Transformation)

~~~
cmehdy
You call it rigorous, with a solid underlying conceptual structure, and
repeatable results. Is there a gap between that and "being scientific" ? I
have no particular feeling about hypnosis and no experience with it, but am a
bit curious about why you would say that calling the practice not scientific
is not undeserved. What are the missing bits to allow it to be either
considered scientifically sound (or on the other end of the spectrum, to
debunk it) ?

~~~
carapace
That's a fascinating and (IMO) extremely important question.

Hypnosis in general and Neurolinguistic Programming specifically are regularly
panned by skeptics, and have not been scientifically well-documented, yet
there is definitely "something there".

I'd love to "do science" to NLP, but I'm not qualified and have other things
to do. (I got rid of my depression and the urge to study psychology waned.)

> am a bit curious about why you would say that calling the practice not
> scientific is not undeserved.

It's just that a lot of practitioners and promoters haven't been completely
scrupulous IMO about making NLP out to be _more_ scientifically-grounded than
it is.

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watertom
Effective solutions to deal with emotional and psychological issues are only
effective if they are compatible with the individual being treated.

Unlike physical issues, where fixing a broken leg is the same regardless of
the patient, emotional and psychological issues require trial and error, but
most people don’t understand why it’s necessary to try different solutions, so
they just assume it’s all quackery, and avoid the problem entirely.

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sethetter
> I am constantly worried by the history of how many things we historically
> applied historical-purposeful reasoning to, totally confident at the time
> that our explanations made sense – which we now know are not historical-
> purposeful at all.

I worry about this a lot too. We tend to make sense of the world through the
stories we apply to our experience, but with unreliable memories and a desire
to find a story that fits what we want to think, confirmation bias even about
our own identities leads us to false conclusions.

------
gerbilly
Maybe new therapies really do work better simply because they are new to the
therapist.

This could create more engagement and enthusiasm on the part of of the
therapist leading to better outcomes.

------
djsumdog
Years ago I was recommended "The Antidote: Happiness for People Who Can't
Stand Positive Thinking"

It's not a therapy book really; it's listed in the self-help genre. Still, I
love it because it talks about all the problems with self-help books. The
author goes to motivational talks, finds a person who grudgingly and
unenthusiastically yell, "I'm so motivated" and later tells the author his
trip to the talk was paid for by the parks department he worked for; he don't
really want to be there.

The author does a deep dive into what's wrong with the motivation book culture
in general, how we should not be afraid of our failures or how the quest to
feel good all the time might be to our detriment. It's a great read.

The article here seems to be arguing more that all therapy books are either
the same or claim their method is better when it's not significantly
different, or they promise exergerant claims of totally turning ones life
around when they really don't; how therapy is often a slow though out process
with gradual changes.

It seems to fit inline with stuff in The Antidote from the perceptive of self-
help books. It's a good read.

------
whiddershins
Just for context, if you are new to the linked blog, Scott Alexander is
writing from the perspective of a working psychiatrist, who tries to
rationally evaluate the effectiveness of treatment methods for real-world
reasons.

This essay about SSRIs was one of my first exposures to his writing, and I
found it very interesting.

[https://slatestarcodex.com/2014/07/07/ssris-much-more-
than-y...](https://slatestarcodex.com/2014/07/07/ssris-much-more-than-you-
wanted-to-know/)

The linked essay is setting context for a series of reviews on various therapy
books.

------
woodandsteel
Here's something you need to know. There is a widely-held belief that
psychotherapy is either helpful or useless. Actually, studies have shown it
can also be quite harmful. In particular, some therapists help most of the
patients, some therapists have little effect on most of them, and some are
outright harmful most. I have spent time observing group therapists, and that
fits what I saw. I have also asked experienced therapists to think about the
various therapists in their community and how good or bad they are, and they
came to a similar conclusion.

Also I used to teach listening skills, which everyone agrees are basic to
being a good therapist. I did several workshops with therapists at mental
health clinics, and it was quite shocking how many of them were awful
listeners.

That means if you find yourself with a destructive therapist, you need to
leave as fast as possible. And how do you tell? I would say the best sign is
if you feel comfortable talking to the therapist and feel like they value you
as a person, or feel yourself tighten up around them.

------
woodandsteel
"All psychotherapy books bring up the Dodo Bird Verdict – the observation,
confirmed in study after study, that all psychotherapies are about equally
good, and the only things that matters are “nonspecific factors” like how much
patients like their therapist."

One of fathers of this idea was the psychologist Carl Rogers. He didn't have
much to say about personal historical causes. But back in the 1950's he
developed the theory that success in psychotherapy depended on the therapist
being empathic, affirming, and honest. He and his associates went on to do a
number of studies that seemed to confirm the idea pretty well.

------
woodandsteel
Alexander is a very bright fellow with lots of insights. However, he is a
psychiatrist. I bring this up because psychiatrists are trained mainly to
diagnose and prescribe drugs, and don't really understand psychotherapy very
well. When I was in the mental health field, there were a fair number of
psychiatrists I had some association with who practice psychotherapy, and none
of them were any good.

------
o09rdk
Alexander is maybe reading the wrong therapy books and literature. He should
look up Bruce Wampold's research, for example. The dodo bird effect is well
documented: therapy works relative to all sorts of placebos, but therapist
effects dwarf therapy effects, not everything works for everyone, therapist-
client cohesiveness is paramount, and there are really no replicable
superiorities of any given therapy with regard to general functioning and
well-being, even if specific therapies might be more effective for specific
behavioral problems.

To be fair to Alexander, therapy research and literature has the kind of weird
duality he points out, and it permeates academics as well, where the problems
he mentions are maybe even worse. Everyone does know about the dodo bird
effect, but then people either embrace it or they ignore it.

A big problem is the exact same thing that's permeating all of medical
science, which is a huge pressure to obtain grants and notoriety for
discovering a cure. There's much more rewards for overhyping than being sober
in science. You could replace therapy with drugs in his essay and it would
read the same. In fact, I sincerely was confused for a bit by his figure
because the exact same sorts of figures have been published about psychiatric
medications, and it took me a while to be sure what he was talking about.

One thing that's maybe not immediately clear to the general public is that
with psychiatry and psychology there's an additional pressure to "be
scientific" which then often backfires in the way he's witnessing. Both
psychiatrists and psychologists are the targets of witch doctor labels, which
then leads to this behavior where researchers and theorists jockey to outdo
themselves in being "real scientists". The good part of this is that then you
get a ton of randomized controlled studies and so forth, but the downside of
this is you end up with this additional reason to promote your drug or therapy
as being somehow better than treatment as usual, or to denigrate other
interventions as being "unscientific". That is, certain things (e.g., CBT in
therapyland, or arguably things like prozac in medicationland) become banners
that you're expected to carry if you want to be part of the "real science"
club. Criticizing the efficacy of these interventions implicitly doesn't just
mean criticizing those particular interventions, or criticizing the
specificity of their mechanisms, it means you get labeled as not being on
board with the "real science" club. It is just one more reason for hype, in
addition to the typical hype that is flooding biomedical research at the
moment.

Alexander mentions that he feels like he's never seen "sudden, extraordinary,
long-lasting" effects of therapy. I'd suggest it's one of those situations
where you get to pick 2 of 3, nothing more.

