
Have we overestimated the effectiveness of psychotherapy? - laurex
https://digest.bps.org.uk/2017/03/20/have-we-overestimated-the-effectiveness-of-psychotherapy/
======
com2kid
Problems with therapy:

A. No standards of treatment. It is therapists choice, and therapists are free
to pick and choose whatever they want. Because results are so hard to measure,
therapists who are really bad at their job can continue to operate, dragging
overall results for the field down.

B. Licensing requirements are all over the place. From psychologists with PhDs
from well established institutions, to people who got an online professional
degree. The type of training someone receives heavily impacts their approach
to therapy, and the quality of their education determines how high quality
their treatment program can be.

For fun sometime, pay the arm and a leg it costs to get a full battery of
psychology tests done from a psychologist. You'll get a personality test and
an actual IQ score. It takes a long time (multiple sessions each lasting a
couple hours), but you will get to see the real scientific part of psychology.

I actually got a practical result out of it. My doctor was able to tell me
that the reason I kept dropping cups was due to a co-morbid congenital
condition. Apparently a certain % of people who have an underdeveloped optic
nerve also have weak grip strength.

The grip strength trainer I bought has more than paid for itself in saved cups
and glasses.

~~~
nickbarnwell
A) With regard to "no standards of treatment", that is not the case, at least
in the US. Licensing and professional bodies for both Masters-level clinicians
(LPCs, LMHCs, MFTs, MSWs and others) and Doctorates (PhDs, PsyDs) effectively
mandate therapists rely on evidence based practices, and insurance companies
are quick to push highly manualised behavioural therapies.

Private practice is one thing, but treatment outcomes _are_ tracked in CMH
settings as well as IP psychiatric settings.

B) Licensure is _not_ all over the place. At a bare minimum, an independent
clinician in the US will have several thousand hours of client contact (e.g.
group facilitation), a thousand to fifteen hundred hours of 1:1 counselling
with clients, a hundred hours of supervision, and have taken two years of
graduate level coursework on psychology and psychotherapy, with the curriculum
on its way to being standardised nationwide by CACREP.

Studies have demonstrated that treatment outcomes are not strongly correlated
with clinicians' educational background, and that the perceived therapeutic
alliance is the strongest predictor of success.

There are problems with psychotherapy research, but they're mostly those
shared with the rest of the sciences.

~~~
gusts
pfft I like to ask every doc I go to, what outcomes they have produced in
cases like mine and how many such cases they see a year. The CBT ppl just
blink at me like the question is not on their manual. And one even said no
great outcomes but here are the things you should do. Why would I spend my
time doing them if they haven't produced results?

I mean these are nice people with good intentions but so is a priest in a
church or a temple. The whole thing feels half baked. Ya ya I know
reprogramming the mind is complex and this is a work in progress. But my
experience from work and coaching team sports is people follow authority
figures when in doubt/outcomes are unknown. And most shrinks and counsellors
in my case atleast are unable to establish authority.

~~~
overton
+1 I'm pretty sure multiple rounds of CBT made my anxiety disorders worse. The
approach attracts hyper-rationalist types who aren't willing to say anything
other than "Your thinking patterns are wrong, you need to fix them." No
serious discussion of trauma, identity issues, or relationships. Pure
gaslighting. Recently, I finally realized that what I needed was some serious
introspection and an empathetic therapist who would help me work through it.
For all the bluster about psychoanalysis being quackery, I'm not sure you can
disagree with its basic premise that maladaptive personality traits are likely
to come from the social context you spent most of your first ~18 years in.

~~~
jm__87
Wouldn't many of your thinking patterns have come from your childhood and
teenage years? How did none of this come up when you did CBT? Also, how did
you do CBT without serious introspection? It sounds like the therapist you did
CBT with just wasn't very good.

------
methodover
I’ve wondered for a long time about crowdsourced “therapy” — a kind of it,
anyway.

I don’t want to just hear myself talk for an hour, which is usually what
therapy amounts to for me anyway. I want other perspectives. I want to hear
other people whove been through what I’ve been through talking deeply and
honestly about their lives. And I want enough perspectives that I can figure
out for myself what modes of thinking, strategies, etc, I might make the most
use of.

The problem is most people are incredibly closed. Myself included. We don’t
talk about our internal mental life as it relates to the outside world. Well,
we do - but not with much transparency. And we don’t talk about our personal
histories, our childhoods, our teenage years, etc. We don’t talk about the
intimate details of our lives.

(And we really shouldn’t; to be clear. Not in a way that can be traced back to
us. Much of personal histories are deeply embarrassing.)

And yet, we’re supposed to figure out on our own what’s normal and what isn’t.

I feel like I’ve spent literally years learning things that other people
figured out a long time ago.

I’ve been thinking for a while about making a website that’s 100% anonymous
(but moderated), but encourages people to write honestly about their own
lives.

No advice. It wouldn’t be about advice. It’d be only a repository of
individual experiences.

I feel like such a site, if done well, could be a real boon to people who are
struggling to figure out life, as I was.

~~~
aizatto
I built a platform for myself to think about life's deepest questions, and
I've been going around asking people their questions.

On my business cards are different set of questions, and here are some of the
answers

[https://www.deepthoughtapp.com/packages/189/business-
cards-i...](https://www.deepthoughtapp.com/packages/189/business-cards-
introduction/)

So far I have 50,000+ questions, 3,600+ answers (mostly mine)

The platform isn't about advice, it's about people answering the deep
questions to themselves.

------
dnenandz
I have undergone CBT with 5 therapists and so I am quite experienced with it.
Every time I have been left completely and utterly disappointed.

One of the unfortunate problems I faced with psychotherapy was the convenient
shift of outcome being dependent on the quality of care given by the therapist
to the mental fortitude of the patient following through on their exercises.
In every case it was my fault that I wasn't progressing, and I found this to
be extremely frustrating.

It would go something like "Did your CBT methods help you not have a panic
attack?", "No they didn't work and I threw up and collapsed in a Starbucks
bathroom". "Oh well just practice more and identify those bad thoughts better
and earlier and do some more breathing exercises and it will work out fine!"

My very last encounter with psychotherapy is when I went to a doctor and
explained that CBT doesn't work for me and that I was looking for someone else
who practiced other methods, and yet again they claimed that I needed more
practice and that I probably had not mastered CBT. Although we don't practice
lobotomies anymore, if you have severe issues mental health treatment is still
in the stone age.

~~~
Aaargh20318
I've undergone CBT too and it always felt like quackery to me. The point of
CBT seems to be to get people to accept their shitty circumstances instead of
actually fixing things. Psychology is the new religion. Instead of saying
"accept your shitty life, you'll be rewarded after death" they are saying "you
think you have a shitty life, but you just need to look at it differently".

CBT felt like an exercise in self-deception to me. The 'bad thoughts' are a
result of the shitty circumstances in life, so shouldn't we be working on
those instead of trying to convince myself that shit doesn't stink ?

I strongly believe that 99% of people who visit a psychiatrist could be cured
by just handing them 20 million dollars. That would return a persons freedom
and remove a huge amount of stress-factors.

~~~
jm__87
_CBT felt like an exercise in self-deception to me._

And what makes you think your current perception of the world is completely
perfect and unbiased? Perhaps the problem is that you are convinced that you
have the most accurate picture of the world and aren't questioning it.

~~~
J-dawg
My own experiences with depression have made me think you’re both partially
correct.

I feel like happiness _is_ about learning how to deceive yourself. It’s about
learning how to put a positive spin on everything, and internalise it.

I struggle with this because I don’t want to deceive myself. But then I’m
probably deceiving myself in the opposite direction with all sorts of negative
thoughts.

~~~
jm__87
Personally, I have found it helps to just always try to take a pragmatic
perspective: how is what I'm doing right now helping me achieve what I want in
life? If you spend an hour thinking about how you suck at various aspects of
your life, how is it making you feel? When you feel that way, are you in the
best state of mind to achieve your goals? Absolutely not. So you need
strategies to deal with those useless thoughts. Distract yourself with
something else or reframe your thinking somehow. In the long run, the ideal
would be to not have those unhelpful automatic thoughts at all (this is what
therapy is for) but in the short run, they are there and you gotta find a way
to deal with and manage them if you want to move your life forward.
Meditation/mindfulness can be extremely helpful in this regard. I'd highly
recommend "The Mindful Way Through Depression" to learn some techniques to
help. The goal here should be to catch yourself sooner when you're thinking
unhelpful thoughts instead of marinating in them for a long period of time
(and creating a more negative effect on your mood) and learning a strategy to
get out of that mode of thinking.

~~~
Aaargh20318
> If you spend an hour thinking about how you suck at various aspects of your
> life, how is it making you feel?

It doesn't matter how you feel about it. You need to focus on the bad things
in life if you want to have a chance of improving things. Burying your head in
the sand doesn't solve anything. Don't waste your time focussing on the good
stuff, it doesn't need fixing.

If all you want to do is feel good despite everything around you being shit,
why not just do heroin ? You'll feel great and it's a lot less effort than
convincing yourself that black is white.

~~~
jm__87
How is it that how you feel about yourself does not matter? It matters quite a
bit. I also never said to bury your head in the sand and not improve anything?
What I am saying is actually the exact opposite of that. Let me give an
example: suppose you wanted to get in shape by going to the gym. You can sit
around and think "I'm so out of shape", "I'm going to embarrass myself at the
gym", "I won't be able to keep it up", etc. None of this is helping you with
your original goal, which is going to the gym and getting in shape. Not only
that, these thoughts are driving your mood down and making it less likely you
will follow through on your plans, not more likely. These are the exact type
of thoughts which depressed people deal with every single day. You can't just
force them to stop occurring whenever you want, this is just what depression
is. The ideal would be to change whatever core beliefs and assumptions are
leading to these thoughts, but making that change with therapy can take a very
long time. What you can do is take a more proactive approach early on to
recognize these thoughts when they occur and deal with them every single time
they come up (which will depend on how depressed you are). This may not stop
the thoughts from occurring but you will have a strategy to keep yourself from
self-defeating behavior.

~~~
Aaargh20318
> You can sit around and think "I'm so out of shape", "I'm going to embarrass
> myself at the gym", "I won't be able to keep it up", etc. None of this is
> helping you with your original goal

But they are _true_ though. If it’s a choice between being miserable and
acknowledging the truth, or being happy in a delusion of your own making, I’ll
choose the truth every time.

I think people are being labelled as depressed way too often. In many cases
it’s just a natural reaction to having a shit life. Anyone would feel like
crap, it’s perfectly normal. The solution is to fix your life, not to convince
youself nothing is wrong. If you don’t manage to delude yourself, if you see
the world as it actually is, you get labelled as ‘depressed’. It’s not because
you have to work 2 minimum wage jobs to make ends meet that you feel like
crap, no something is wrong with YOU. CBT is basically a form of victim
blaming.

~~~
jm__87
You are very confused. I'm not saying those things aren't true. I'm saying
they are just unhelpful. I'm not saying to delude yourself by saying
"Actually, I am in shape", "I will never embarrass myself at the gym" or "I'll
be able to keep this up forever". I'm saying, think more productive thoughts
that will get you closer to your goal. For example, you say to yourself "I'm
so out of shape. I hate how I look". What you want to do is catch yourself and
ask "How are these thoughts helping me get in better shape?". They aren't.
They are only hurting you. Going to the gym and working out is what will get
you in shape, regardless of whether your thoughts are positive or negative.
But thinking negatively all the time will sap your motivation and enjoyment of
life.

Edit: I also want to acknowledge this:

 _If it’s a choice between being miserable and acknowledging the truth, or
being happy in a delusion of your own making_

There are clearly other choices here that you are missing:

\- Think about something else that is not going to make you feel miserable.
Take your dog for a walk, listen to some music you like, meditate. Relax,
enjoy life.

\- Reframe your negative thoughts. For example, if I think "I'm going to
embarrass myself at the gym, I might as well not go". A way to reframe this is
"so what if I embarrass myself at the gym? I'm not an expert at lifting
weights and working out and that is plainly clear by me being out of shape. If
someone else doesn't like what I'm doing or the way I look, that is their
problem. I'm trying to do something good for myself here and I'm not going to
let other people get in my way".

\- Stop thinking your negative thought and make an action plan to fix it. For
example "I'm so fat and out of shape". This will make you feel shitty for a
brief period of time, but writing down a real plan that you can do to resolve
the problem will make you feel better. The plan has to be doable. A lot of
people make huge plans that are very difficult to execute. To make a doable
plan to resolve a problem, you first may need to break the problem down in to
smaller chunks. Also, it is important to remember that it doesn't matter if
someone else was able to accomplish the same thing you're trying to do with
less effort. The only thing that should matter to you is getting the results
you want.

\- Tell yourself to worry about the problem later. Again, "I'm going to
embarrass myself at the gym". Is this really a problem for you right now if
you're not planning to go to the gym until tomorrow? It is not a problem for
right now. Shelf it for later and do something right now that can make your
life better.

\- Question your thought. Back to embarrassing yourself at the gym. You're
making an assumption that the fit people at the gym are going to see an
overweight person doing something incorrect and they will ridicule you for it.
In reality, it is very likely that some of those people in the gym were once
in your shoes, overweight and down on themselves and lost as to what to do. It
is perhaps equally likely that someone will see your efforts and come over and
offer you encouragement and advice. You may even make some friends.

\- One last thing can just be to accept the thought as reality and move on.
The thought: "I won't be able to keep this up forever". Well, that is probably
true, but does that mean you shouldn't try? Do you respect people who quit
before they've even started? Your own internal response to this should be "I
can't keep it up forever, but I can try my best because that is the type of
person I want to be" and leave it at that. And you may even be wrong. Maybe
you can keep going to the gym until you're 80. Or another thing to ask is if
this thought even matters? Your goal is just to get in shape in the near
future, not have a six pack in your 80s.

~~~
jabbadabbadooba
\- "But thinking negatively all the time will sap your motivation and
enjoyment of life."

The thing is that people are not always embarrassed, because they like to feel
embarrassed. You'll get comments, snarky, clever remarks that will stick in
your head. You'll get people staring at you, pointing at you, laughing behind
your back just in earshot. They'll twist the truth, saying your lazy or
dimwitted. Those things make you feel negative too. Now you'll say, "but you
got to break the vicious cycle!", but that's so easy to say. Even if you've
been through the same, your experience is completely different. People get
depressed because they see the work ahead to break out of that circle, and if
it's big enough they start to contemplate their existence in life. Because at
some point you'll learn, that after breaking this vicious cycle, there's a
next, and a next. And the reward is often too small. It also definitely
doesn't help that some people have it easier only because of sheer luck, and
those same people will be the ones keeping you down - "where you belong".

Edit: For the record, I also think CBT sucks

~~~
jm__87
I think what it comes down to is self compassion - you have to care about
yourself, especially if you believe no one else does. This is something that
doesn't just happen. You have to practice self compassion and do things for
yourself. Another approach to build some self compassion is loving kindness
meditation. Once you have some self compassion you can forgive yourself for
some of your own faults. As you said, some of us are lucky and some of us are
unlucky. Just like it's not the fault of the lucky people that they had good
luck, it too is not your fault you had bad luck. Best not to dwell on what you
can't have - all you do is torture yourself for no reason - and just focus on
what you can have.

Edit: regarding what other people think, it is best to just focus on what you
know to be true and challenge anything that could be potentially untrue. If
someone ridicules you, they're a jerk. But don't engage in any sort of mind
reading exercises. It is pointless torture. Focus on what you want for
yourself and don't let other people's opinions distract you from your goal.

~~~
jabbadabbadooba
You're right of course, and this is something I've recently began to learn for
myself (thanks for re-asserting). I just think this is a very difficult lesson
to learn, since it goes so much against our social instincts (as humans).

------
tombh
I'm not psychotherapy's biggest fan, but I did do 2 years training in it, and
I must say the world is a better place for psychotherapy's existence. Because
before psychotherapy we were cutting bits of people's brains out and
electrocuting them. For all Freud's frankly odd theories he was the first big
name to stand up and suggest that well intentioned dialogue was enough to help
traumatised people.

It's not rocket science, we don't need any big theories or research to know
that talking helps. And of course by that same token some combinations of
client and therapist are going to be constructive and some damaging. I believe
psychotherapy is first and foremost an institution of accountability not
academic theory.

~~~
cat199
> we were cutting bits of people's brains out and electrocuting them

in some cases. in other cases not.

see also: monasticism, healthy spiritual/religious practices.

~~~
Noos
...monasticism was never healthy. I really defy someone to read the Rule of
Saint Benedict and not think of a modern prison at least once. Monasticism is
even considered spiritually dangerous at times, and is linked to its own
specific sin, Acedia:

[https://en.wikipedia.org/wiki/Acedia](https://en.wikipedia.org/wiki/Acedia)

I recommend Kathleen Harris's The Noonday Demon for a good account of that. If
anything, monastic life would destroy you if you suffered from depression, not
heal you.

------
pmoriarty
Therapy has really helped me, for a number of reasons:

\- It helped reduce my stress level and helped me cope.

\- My therapists have made constructive, useful suggestions and provided
insights that I hadn't thought of on my own.

\- I've faced and dealt with things I've avoided facing and dealing with on my
own.

\- I've come to understand myself much better.

Those things alone are worth their weight in gold for me. That said, I've
completely avoided CBT and related short-term, "evidence-based" therapies.
Instead, I've preferred to work with therapists who have more of a Jungian,
depth psychology approach, which are a much better fit for me.

In addition to therapy, in recent years I've been eating a lot healthier,
started exercising and supplementing nutrients that I was deficient in and all
of these changes have had a very positive effect on my mood, health, and
energy level.

I also journal a lot, and that also helps me to destress and put things in
perspective. It's often almost as good as talking to someone.

Back to the subject of therapy: I believe it's absolutely critical to find a
therapist that you like, respect, and can easily talk to and open up to. The
other half of the equation is your own willingness and ability to put in the
hard work of both confronting the difficult issues you need to in therapy and
following through outside of therapy. Without all of these things coming
together, the results are likely to be disappointing.

------
s-shellfish
I've shared similar sentiments in various threads, but yes, for some people
psychotherapy has an adverse effect.

I honestly believe this happens because the person getting therapy does not
respond well to hyperfocus on themselves. There's a point at which oneself
must be able to say 'yes, I'm okay, I don't need help anymore' and modern
psychotherapy doesn't really have anything beyond 'algorithms' to really
establish that.

Once labeled ill, it feels like it can be with you forever. I'm sure some
mental health care professionals believe that's an essential crutch mentally
ill people need, but from personal experience it can be just as handicapping
as it is intended to be helpful.

Sometimes people just want to know they'll be psychologically fine
independently, and that's not something psychotherapy can prove to a person
while guiding them.

It's not an easy problem, but it exists. Also, pointing out problems doesn't
mean oneself created them. It's something humanity needs to work on
collectively.

------
robbrown451
What I'd like to see is a comparison of psychotherapy to just paying a normal
person with common sense but no psychological training to sit and listen and
talk to people to help with their issues.

I'm convinced that the latter would be more effective most of the time, but
I'd love to see it studied.

~~~
projektir
Same, I often feel that therapy is filling in a gap that really should be
filled by friends and communities. Therapists at least have the training to
not tell depressed people to cheer up, though.

~~~
J-dawg
I’m stuck in this situation at the moment. I’m seeing a therapist but my main
problem is loneliness. I find I look forward to our sessions just because I
get the chance to talk to someone for an hour, but I’m not sure whether I’m
gaining much else from the therapy.

------
leot
Certain treatments have outcomes with high variance even when practiced
perfectly.

Combined with no clear way to evaluate whether the treatment is being applied
well, this makes it difficult for practitioners and patients to evaluate
treatment quality. Which discourages expertise development in the first place
(why bother working really hard when the results are hard to pin down
anyway?).

------
meesterdude
> For the reader undertaking psychotherapy or who knows someone who is, it is
> worth keeping some perspective: this is just one critique and the weight of
> evidence still suggests that psychotherapy is, more often than not,
> beneficial.

It's good to bring a more critical eye to the field - but be mindful that it's
still overall beneficial. My own experience has lead me to find it helpful,
but not able to really address the core of issues. And maybe that's too much
to ask for - but it's certainly not something they object to trying to
address.

------
themodelplumber
> Evangelou and his team conclude that the field of psychotherapy research
> needs to work harder to ensure that negative results are published as well
> as good news results, especially given the findings of another recent paper
> suggesting that the field has a problem with undeclared researcher
> allegiance to particular therapeutic approaches.

And from that other recent paper:

> Reviews with a conclusion in favour of psychological therapies (vs
> pharmacological interventions) were at high risk for a spin in conclusions

For a field so rich in therapeutic models, I find it somewhat surprising that
people are not more educated, walking in to visit with a therapist, as to what
kind of model or therapy is being used, and what alternatives might be
available.

I'm not a psychologist myself but rather a coach, and I love taking little
breaks with my clients to move to a meta-perspective and walk them through the
variety of models we can use together. Eventually they learn that each model
has key leverage points as well as key weaknesses, and tying oneself to a
single model as if it has no significant blind spots can quickly put one's
desired outcomes at risk.

Maybe some psychologists here can weigh in; perhaps this is already a thing in
the therapy world.

~~~
projektir
> For a field so rich in therapeutic models, I find it somewhat surprising
> that people are not more educated, walking in to visit with a therapist, as
> to what kind of model or therapy is being used, and what alternatives might
> be available.

This seems like a bizarre expectation to me. People walking in about a stomach
problem generally don't know much about that subject, either. I'm not sure
what the ratio is, but unless you only see people from a very narrow
background, I don't really see why the average person would be educated in
psychological techniques any more than they're educated in types of rock.

------
davidy123
When I worked in the health system, specifically around pain relief, there was
a comparison of different approaches. Among them was "distraction therapy."
That phrase has stuck with me, and I think it applies to many therapies people
are mentioning here. It's basically a variation of "hit your head so you don't
notice your sore elbow." But with the right application I think it can be
entirely positive. If the attention required of therapy X shifts you away from
problem Y, even if it's not really "helpful" on its own, then it's an
excellent therapy. This is why some people realize they'd rather get a gym
membership than therapy sessions. That said, I think psychotherapy, as an
intentional focus on underlying or neurochemical issues, can go much deeper
than this approach and should be considered by many people (though positive
results could themselves be considered a 'distraction' if they don't address
an inherent problems).

------
carapace
I happen to have some knowledge and experience with something called "Neuro-
Linguistic Programming". It's a rigorous but unscientific body of ideas and
techniques that roughly amounts to an "operating system" for the human mind.

(From the POV of a computer programmer it is interesting to note that the
origin of NLP involved the analysis of videos of therapy sessions of a few
highly effective therapists[1], done with the aid of Chomsky's
Transformational Grammar, which of course is related to the Chomsky hierarchy
of grammars...)

I've always been disappointed that whenever people "do science to" NLP it
seems to fall flat. I have to assume the studies are flawed somehow because I
personally know damn well the techniques work. Yet the wikipedia entry is all
about how it's a pseudoscience. It's a very frustrating situation.

[1] Virginia Satir, Fritz Perls, and Milton Erickson, I believe were the main
ones.

~~~
tomhoward
I have a similar experience with a mix of therapies I've undertaken over the
past few years.

The main ones I've used are NET, kinesiology, EFT/tapping and holotropic
breathwork, and a bit of Erickson hypnotherapy.

I've been aware of NLP and dabbled in it a little about 10 years ago, but
ended up finding the abovementioned approaches more effective for my issues.

But they seem to work at the same level; like NLP, NET and kinesiology focus
on finding _incongruence_ in the body and mind, and undertaking a
learning/healing process to enable transitioning to a state of _congruence_.

After 6-7 years of this work, I've almost completely overcome chronic fatigue,
anxiety (social & general) and depression, as well as several other symptoms I
can now recognise in retrospect (possibly a combination of
borderline/histrionic/narcissistic PD symptoms).

There is some research indicating the effectiveness of NET [1], but it will
have a hard time gaining mainstream acceptance given its origins/professional
associations and the specifics of the treatment.

It's also super-hard to do a full-scale trial for these kinds of treatments,
as it's very difficult to assemble cohorts of subjects with similar enough
symptoms, and the it takes years for really profound changes to happen. So
it's hard to imagine who would have the funds and the timeframes required to
undertake the kind of study that would be necessary to properly test this
stuff - not to mention who would have the incentive, given that there's no
drug patent pot of gold at the end.

Yet year by year I keep doing these practices and my life keeps getting
better, while I watch on as other people I know keep persisting with
conventional psychology and psychiatry, without a whole lot of success beyond
the superficial.

I've come to understand enough about what keeps the status quo in place to no
longer be frustrated by it. My approach now is to share my experiences with
whomever is interested, and trust that those who need/want to know about will
take notice give it a try when they're ready.

Enough people have given these techniques a shot and gotten great results that
I'm optimistic that more widespread acceptance can happen eventually, somehow.

[1] [http://www.onefoundation.org/current-research-
updated/](http://www.onefoundation.org/current-research-updated/)

~~~
duggable
This sounds really interesting, and a comment like yours is exactly why I came
to this thread.

    
    
      Yet year by year I keep doing these practices and my life keeps getting better [...]
    

Would you mind sharing more details on how you practice the above?

~~~
tomhoward
I've learned to tread cautiously with this stuff as it's a topic that triggers
hostility in some, though plenty of others like yourself are looking for this
info, so I'm happy to risk the backlash if it might help someone.

I should emphasise that anyone experiencing mental illness should consult a
mainstream psychiatrist first, in case they need medication or other
professional care. The techniques below are for people who have a solid
baseline of mental health, but want to find better success and happiness in
their career, relationships, etc.

For NET, search for "NetMindBody" and find a local practitioner. They're all
over the world. Alternately, look for Psych-K or BodyTalk System - they're
variants of the same concept. Ultimately you'll want to learn how to do it
yourself rather than paying a practitioner, so you can search Meetup.com for
"muscle testing" and you might find a local group and meet some like-minded
folk on the same journey.

For "holotropic breathwork", a Google search will point you to solid info and
local instructors. FYI it was conceived by Stanislav Grof, a psychiatrist who
pioneered research into LSD before it was outlawed.

EFT/tapping is all over YouTube. Its biggest proponents push it as a be-all-
and-end-all, but for me it's only been a small component of the overall
approach, though still an important one at times.

Practitioners of Erickson hypnosis are everywhere, so it should be easy to
find someone local. This one has also been minor for me but still valuable.

A well-known book offering some science behind the mind/body congruence
concept is Bruce Lipton's 2006 book the Biology of Belief [1].

Lipton is a credentialed scientist himself (PhD cell biology researcher at
Stanford School of Medicine), but he gets hand-wavy about concepts like
epigenetics and quantum entanglement and leaves himself vulnerable to attack
from mainstream skeptics.

But it's only by applying the principles he describes that I've been able to
make the progress I've made over the past 6-7 years.

For more info, you're welcome to contact me directly - email in bio.

[1] [https://www.amazon.com/Biology-Belief-10th-Anniversary-
Consc...](https://www.amazon.com/Biology-Belief-10th-Anniversary-
Consciousness/dp/140195247X)

------
totierne2
I participated in 3 CBT sessions 10 years ago I asked what will I get out of 6
sessions (the most my employer would pay for). The therapist said I would know
my problems but not solved any of them. I did not attend any further sessions.
I am a male programmer with bipolar. I did try a excel based survey labelled
CBT which quantified where I was on general personality traits which was OK
and free. I did read some popular therapy books. I could probably do with more
work focussed excutive coach lite training if I could avoid the bad ones. I
called works employee helpline recently, after a manic episode, I will see how
that goes, it is more of a seen to be doing something rather than letting
mania (occasionally) take its natural course.

------
wskinner
This article could be summarized in two sentences, both of which should be
unsurprising to most HN readers:

1\. Publication bias means that the reported results for efficacy of
psychotherapy are likely to be stronger than the actual efficacy. 2\.
Observational studies showed a negative relationship between mental health
outcomes and psychotherapy.

The clickbait title aside, 1 is not really news as this bias affects every
field, especially social science, and has been widely reported. 2 is basically
a no-op. You cannot under a causal relationship based only on observational
studies. Full stop. The idea that people who developed poor mental health
sought professional help is if anything more plausible than the clickbaity
alternative.

------
softwaredoug
From the article:

> For the reader undertaking psychotherapy or who knows someone who is, it is
> worth keeping some perspective: this is just one critique and the weight of
> evidence still suggests that psychotherapy is, more often than not,
> beneficial.

~~~
beagle3
Does anyone have dependable reference for that?

------
Ensorceled
I’ve had terrible martial arts instructors, inept teachers, ineffective
professors, one brutal physiotherapist.

I presume that there are a fair share of bad psychotherapists as well.

That some people do not see improvement should not be surprising.

~~~
sonnyblarney
I don't think anyone would suggest that there should be perfectly consistent
outcomes, rather, on the whole that outcomes should be positive. We know there
will be poor performers.

The study is suggesting that 'on the whole', there are negative outcomes,
implying that 'most psychotherapists' are just bad at what they do, or more
likely, there's a more fundamental issue with the nature of psychotherapy
itself.

------
raverbashing
Proponents of more "evidence based" psychotherapies usually oversell their
"scientific" rigour (even if there are several question on their
reproducibility) while usually leaving the patient's own characteristics in
the background plane (or just ignoring it).

Realizing what you are feeling/thinking and being able to say that is halfway
to the solution.

And yes, it is very dependant on practitioner and on the patient's own
willingness. (In the same way exercise is good but if you run 100m per day or
lift light weights at the gym it won't do much)

------
perseusprime11
The untold truth is that therapy is not for all people. Similarly, meditation
is not for all people either. For some people, neither therapy nor meditation
really work. For those people, medication to elevate mood is the only real
option. I have seen too many therapists exploit this and raise hopes of their
patients and try CBT for a long time without results. Just like any disease,
you need to manage this and there is nothing wrong in taking medication to fix
yourself.

------
jm__87
My viewpoint on mental health: how you feel at any given moment and how long
that feeling will persist will depend on the structure of your brain and the
environment in which your brain is in. There are a huge number of variables at
play. This environment includes things like: baseline levels of chemical
signalling of various kinds going on in your brain (this is plainly apparent
when you do any sort of perception or mood altering substance which
significantly changes the chemical signalling in your brain); physical health
of the body attached to the brain; inputs from your senses and any feelings
that may be arising as a result of these inputs; beliefs and assumptions about
the world in which you're in; and finally structural considerations of your
brain (e.g. is some part of your brain damaged or non-existent). For some
people, the majority of problems lie in the "beliefs and assumptions about the
world" variable and for these people, therapy is the answer. I imagine for the
large majority of people, therapy may give some minor benefits but if you
don't attend to your own physical and emotional needs on a regular basis, you
are going to feel like garbage. This means eating a healthy diet (with enough
calories), getting some exercise, spending time with family and friends,
taking some time for yourself to relax and unwind. For those with persistent
chemical signalling or structural problems in their brains, they may have to
do way more to feel right, including getting on the right drugs and therapy
for emotional support. It may suck, but we can only play the hand we're dealt.

A few more thoughts on this topic: the world we live in now is so different
from the one humans evolved in. We eat different food and eat way more
frequently than our ancestors did. We exercise way less and spend very long
periods of time in low to medium stress situations instead of short periods of
time in high stress situations, which is what our stress response system
evolved for. Many of us live semi-isolated lives thinking about how we can
help ourselves as individuals instead of living in small to medium sized
groups thinking about how we can help ourselves within the context of the
group (you would likely have to be doing prosocial things with higher
regularity). While there are many advantages of living in the world we now
live in as compared to how our paleolithic ancestors lived, there are some
incompatibilities with how we have evolved and I think we should be doing more
as a society to address these issues.

------
dboreham
The big problem with therapy is that it is too expensive to be available to
most people. We need to find some viable alternative that doesn't depend on
paying a very costly human to listen for an hour a week.

~~~
LoSboccacc
there are also a lot of quacks around. doesn't help that psychotheraphy really
lacks a solid background in medicine tbh. we're only scratching the surface of
the deep mind structures and issues stemming from there and how they all
relate to trauma or even what trauma actually is and yet pretend like we can
cure ailments talking people out of it.

------
wavefunction
You need some people in your life you click with.

------
Simulacra
It depends. What do you think?

~~~
jowsie
Severely underrated comment.

------
crawfordcomeaux
A big issue I see is this idea of judging outcomes as positive/negative,
instead of accepting people's processes.

After starting therapy, I cut off communication from my parents at least
twice. Is this a positive example of someone who's codependently avoiding
their parents or someone learning to detach from their parents?

Trick question: it's both.

Another issue with measuring effectiveness is we aren't gathering information
about the therapists' beliefs/mindsets. I dropped a therapist because she
started adopting my own parents' financial insecurities, shouted "you're going
to run out of money" at me a couple times during a session. Anxiety over money
was a key issue for me, so I asked her multiple times not to repeat messages
to me that might reinforce my thinking. She ended the session with a comment
about running out of money, so I dropped her.

I've since gotten over my money anxieties to the point that I've essentially
taken a vow of service & poverty as I try to minimize my participation in
capitalism. While I'm happy and love my new life free from worrying about
money or how to meet my needs, I don't know if this would be considered a
desirable therapeutic outcome when considering the rest of society. Of course,
society's wellbeing is also really subjective and we are slow to evaluate our
culture for long-term effects.

I also started practicing Nonviolent Communication 2.5 years ago. For a while,
I was kind of robotic in my communication style after, since I was structuring
most sentences as "When (I|you) <observation without evaluation>, (I|you) feel
<emotions without evaluation>, because (I|you) need <specific human need
without specifying strategy for meeting the need>." Is this temporary rigidity
considered negative? What about any person who sticks with the language they
use throughout their life?

We program ourselves & each other with our words and I view therapy sessions
as guided debugging sessions where I work to figure out ways I've programmed
myself or been programmed that are unsustainable. This perspective is
therapeutically useful to me & the success of my therapy sessions has
deepened, as a result. These days, therapy is more of a safe guard to keep me
in check as I play with my mind and perceptions, though I'm still working on
my anxiety with writing. I don't know how any of that can be accounted for in
these studies and while I may be an outlier, I know that learning to pay
attention to outliers is how innovations can come about.

------
bachbach
My suspicion is that many people going to therapy are lacking in one or more
items from the basic hierarchy of needs.

I went to therapy once. In hindsight I'd have been better off with a
girlfriend and friend companionship.

I'd ask myself.

1\. Am I getting good quality sleep? 2\. Am I getting good quality food? 3\.
Am I interacting with people socially? 4\. Am I sexually active? 5\. Am I
physically active to the point of breaking sweat?

The mental and physical are intertwined and it is easy to forget to take care
of yourself. Your machine requires maintenance.

I don't only mean sometimes take it easy - that too - but also people can grow
very neurotic by ignoring their social and sexual needs, and like a machine -
we are meant to perform functions - without which we can suffer aka a certain
amount of physical or mental stress is good for us and we can err by doing too
little or too much.

~~~
themodelplumber
For a lot of people, deeply subjective-analytical thinking of this sort is
very brittle, and they lack the experience that would teach them what to do
even if they knew they were lacking some important thing on the hierarchy.

It also happens that some very depressed and anxious people will e.g. read
only the "criticisms" portion of the Wikipedia page for the hierarchy concept,
and determine in the end that what they need is an experienced professional
rather than a possibly-unscientific concept. This is really sad to observe,
because their inability to be open to certain kinds of information can make
them more dependent, not less.

~~~
bachbach
It is easy to dismiss 'get laid' as boorish and interpret 'did you get enough
sleep?' or get out more' as semi-accusatory, because we're prone to thinking
crude feedback is less apt for us, we must be more complex than this.

Look at the rise of ASMR videos. Millions of people desire an experience,a
simulation, of being touched in a non-sexual way. This isn't a critique of
ASMR - it's fine - but there's this simple need at the heart of it - little
different to those gorillas grooming each other.

There's a running gag in AMSR circles where the ASMR viewer is interrupted by
somebody and reacts by <laptop lid slam> pretending they were watching porn.

Hackerspaces and makerspaces are a great thing. I heard a quote recently
"Women communicate, men shoulder to shoulder".

------
Pica_soO
Its glorified navel gazing. You can see everything in a navel, especially a
lot of you and how that severed connection from your mother started all this
trouble.

In the end, its some sort of synthetic friendship, which in a ultra-
individualistic society has become rare. But its not resulting in good advice
like true friendship. Its resulting in pushing egomaniac tendencies onwards.

Imagine a psychotheraphist not giving libertarian advice. "You should
integrate more into your family, visit your brother more often, sacrifice a
part of your life to the commons, so that the commons is more willing to
sacrifice parts of its life to you.."

"I had a very bad vibe with that psychotherapist, i came to be unrepressed and
he pushed for even more repression. In fact i think, i need therapy to
overcome this therapy..."

------
ShabbosGoy
The only psychotherapy we need is from plant medicines. DMT and psilocybin are
natural plant teachers that can help us through the traumas we go through in
our life.

~~~
ClassyJacket
I'd add MDMA in there as well. It's had good results in testing for PTSD (look
up MAPS) and it changed my life for sure. Not a plant, but I hold onto no
idealism about that.

~~~
wavefunction
It was commonly synthesized from sassafras oil (safrole) so you can add it to
the list I think:

[https://erowid.org/archive/rhodium/chemistry/safrolefaq.html](https://erowid.org/archive/rhodium/chemistry/safrolefaq.html)

