Different methods of therapy appear to be equally effective despite having theoretical foundations which are conflicting with each other. The common aspect between different therapies seems to be "having someone to talk to", so I'm inclined to believe that really is what's behind the success.
> Different methods of therapy appear to be equally effective despite having theoretical foundations which are conflicting with each other. The common aspect between different therapies seems to be "having someone to talk to", so I'm inclined to believe that really is what's behind the success.
Just because talking is the common trait, doesn't mean that that's evidence that that is all it is. Paying someone to help you with the problem is also a common trait (and ironically, that is, no doubt, a contributory factor), but that isn't all that therapy is.
Let's say that there are three ways to solve a problem, and depending on context that we're not terribly good at determining, one of those ways will work quite often, one will work some of the time, and the other will be a disaster... but there's an equal probability that each of those ways are equally likely to fall in to each of those categories. Statistically, one could claim that how you solve the problem is not behind the success. In a sense, that would be correct, because the real determinant of success would be being lucky with the solution you chose to employ. While one could imply though that really it's nothing more than being lucky at choosing the solution, in reality without all of what's involved in that choice, the problem will remain.
There may be a kernel of truth in this, but it depends on why you're seeing a therapist. For treatment of OCD, for example, or phobias, there are specific protocols that yield results, but they do not respond to just "having someone to talk to."
Other kinds of conditions, like depression and anxiety, respond to a wider range of therapy styles. But those aren't the only conditions that people seek to treat through talk therapy. (And it's also an exaggeration to say that just having any conversation will help to treat anxiety and reopression. But it is probably true that treatment of these conditions is less technical and responds to a much wider range of styles.)
> Different methods of therapy appear to be equally effective despite having theoretical foundations which are conflicting with each other. The common aspect between different therapies seems to be "having someone to talk to", so I'm inclined to believe that really is what's behind the success.
This isn't true. Different methods work better for different problems. I've been in behavior health for 7 years now. It's having someone with a lot of education to talk to, someone with education in social and psychological problems and healthy coping mechanisms.
From what I understand, therapy success rates are quite low, with only cognitive behavior therapy showing notable progress. That isn't to say all the others are categorically useless, only that in the majority of cases, they seem to be ineffective or harmful.
This is very true, and I would add to it that the dominant paradigm in most therapy these days (at least those forms coming from a Cognitive Behavioural Therapy background) have "graduation" as an explicit goal: the client feels like they've addressed what they want to address and no longer need the ongoing relationship.
This is largely due to a crisis in the field in the late 70s/early 80s when several studies demonstrated that talk therapy had outcomes no different than no therapy. In both cases, some got better, some got worse, some didn't change. CBT was a direct result of that, prioritizing and tracking positive outcomes, and from CBT came a lot of different approaches, all similarly focussed on being demonstrably effective.
Talk therapy isn't a cure-all, but it's definitely more results-oriented than it was 50 years ago.
I think the preying part of therapy is that there's just no defined stop condition. There's no such thing as "healthy" in mental health. You get chemo until you go into remission or you die. You take blood pressure meds until you have a better lifestyle and body composition and don't need them anymore, etc. There's no analogue for "you're healthy now, go away so I can help others", and so therapy goes on forever until the patient stops for whatever reason.
> I think the preying part of therapy is that there's just no defined stop condition.
There's no defined stop point for physical development either... Top performing athletes still have trainers, and nobody sees that as a problem. If it's mental development though, it must have a stop point?
I sometimes recommend Dr David Burns' Feeling Good podcast[1], and he is big on measuring and testing and stop points. Instead of 'tell me about your mother' his style of Cognitive Behavioural Therapy (CBT) is called TEAMS in which the T stands for Testing, and it involves:
- Patient choosing a specific mood problem/feeling they want to work on.
- A mood survey, where the patient rates their own level of e.g. anxiety, depression, fear, hopelessness. (e.g. out of 5 or 10).
- Therapy session, following his TEAMS CBT structure. Including patient choosing how much fear they'd like to feel (e.g. they want to keep a little bit of fear so they don't endanger themselves, but don't want to be overwhelmed by fear, 5% or 20%, say).
- A repeat of the mood survey, where the patient re-assesses themselves to see if anything has improved. There's no units on the measures because it's self-reported, the patient knows if the fear is unchanged, a little less, a lot less, almost gone, completely gone, and that's what matters.
That gives them feedback; if there is improvement within a session they know something in the session helped, if several sessions go by with no improvement they know it and can change things up and move away from those unhelpful approaches in future with other patients, and if there is good improvement - patient is self-reporting that they are no longer hopeless about their relationship status, or afraid of social situations, or depressed, to the level they want, then therapy can stop.
He's adamant that a single 2hr session is enough to make a significant change in many common mood disorders[2], and this "therapy needs to take 10 years" is a bad pattern and therapists who don't take mood surveys and before and after every session are flying blind. With feedback on every session and decades of experience, he has identified a lot of techniques and ways to use them which actually do help people's moods change. I liken it to the invention of test cases and debuggers (and looking at the output from them).
I think you're mistaken, at least in a lot of cases. All CBT based therapies I've had have started with a clear discussion about what the problem is, and what the solution looks like in terms of my happiness and mental well-being. In all cases, my therapist has "graduated" me, telling me that they don't think I need to continue (or having me say that I'm comfortable now stopping regular therapy).
CBT and its derivatives very strongly attend to individual effectiveness and view therapy that goes on endlessly as a sign that the real problem isn't being addressed, and that no therapy is considered effective unless it ends. Individual therapists might be bad actors, but the field itself is now admirably focussed on finite, positive results.
It’s implying that this is the case for many people, not all. Which it is, in my experience. Particularly since the advice you gave:
> then you should get another therapist
Seems to be fairly ubiquitous. “Find a therapist you like”/“shop around”/etc. leads a lot of people to find people who will tell them what they want to hear. Sometimes what people want to hear is how to practice CBT - but in that case, such people are probably going to be using AI to work on CBT.
Yeah I have found there is very little you get from therapy that you can't get from a mixture of journalling, learning CBT methods, having a routine (which includes regular exercise) and trying lots of different methods of making friends that you assess maturely for their reliability. Maybe meditation if you're into that. All of these things are free and require effort, personal effort and intention being what will actually improve your life anyway, whether you use therapy or not. This makes therapy seem like a scam for anything other than dealing with a very dire short period of isolation.
GP's not saying that, what GP is saying is "good luck trying to talk to your therapist if you stop paying $$$".
I do think therapists are one of the professions that will be naturally displaced by LLMs. You're not paying them to be your friend (and they are usually very clear on that), so any sort of emotional connection is ruled out. If emotions are taken away, then it's just an input/output process, which is something LLMs excel at.
I would argue the opposite: a good therapist isn't just offering back-and-forth conversation, they're bringing knowledge, experience and insight into the client after interacting with them. A good therapist understands when one approach isn't working and can shift to a different one; they're also self-reflective and very aware of how they're influencing the situation, and try to apply that intelligently. This all requires reflective and improvisational reasoning that LLMs famously can't do.
Put another way, a good therapist is professionally trained and consciously monitoring whether or not they're misleading you. An LLM has no executive function acting as a check on its input/output cycle.
I feel like this is easier said than done. There's not a great way (that I know of) to evaluate the quality/potential helpfulness of therapists... if only there were a Steam-like review system for them! There's ratemds.com, but not a lot of people use it, since there's not a central marketplace to find therapists to begin with (that I know of). I would love to be able to find good therapists locally and/or online. It just seems like such an expensive gamble every time.
When I was younger, I went through many therapy sessions with multiple professionals of different kinds (psychologists, psychiatrists, MFT (marriage and family therapists, social workers, etc.).
A couple of them were wonderful: thoughtful, caring, helpful, providing useful guidance with a compassionate ear.
Another couple tried to be helpful but were still in training themselves (this was at a college) and couldn't really provide any useful guidance.
One was going through a divorce of her own at the time and ended up crying in many of our sessions and having to abort them to deal with her own emotions – it was a tough time for her, and she's only human. I often tried to console her, but she wouldn't let me, so it made for a very awkward situation lol.
One of them had one a single session with me, charged me for it, and then told me she couldn't help me and to go somewhere else.
But the worst of them was an older guy who, despite the referrals and my history, thought I was faking mental illness. He dared me to attempt suicide, and when I eventually did (not because of him, but a separate romantic failure), he chuckled in my face and said, "Heh, you finally tried it, huh? Didn't think you would." This was an older psychiatrist in a small town – either the only one there, or one of very few – the kind of sleazy place that had a captive market and a whole bunch of pharma ads in the lobby, with young female pharma reps going in and out all day. What a racket =/ If I were wiser then, I would've reported him to the board and news media.
So, anecdotally, my success rate with therapists was only 2/7. To be fair, I was a pretty fucked up teenager and young adult, but still... the point is that "just find a better therapist" is often a difficult process. Depending on your insurance and area, there may not even be any other therapists with a waiting list of less than a few months, and even if you can get in, there's no guarantee they are good at their jobs AND a good fit for your personality and issues.
Think it's hard to find good devs? At least our line of work produces some measurable output (software/apps that run, or not, according to specs). How do you even measure the output of a therapist? Improvements to someone's life aren't going to happen overnight, and many never report back; the best successes may not bother to leave a review, the worst failures may end up dead before spreading the word. The rest probably just run out of sessions allowed by their insurance and try to move on with their lives, with unknown levels of positive or negative change.
baobabKoodaa|1 year ago
Different methods of therapy appear to be equally effective despite having theoretical foundations which are conflicting with each other. The common aspect between different therapies seems to be "having someone to talk to", so I'm inclined to believe that really is what's behind the success.
cbsmith|1 year ago
>
> Different methods of therapy appear to be equally effective despite having theoretical foundations which are conflicting with each other. The common aspect between different therapies seems to be "having someone to talk to", so I'm inclined to believe that really is what's behind the success.
Just because talking is the common trait, doesn't mean that that's evidence that that is all it is. Paying someone to help you with the problem is also a common trait (and ironically, that is, no doubt, a contributory factor), but that isn't all that therapy is.
Let's say that there are three ways to solve a problem, and depending on context that we're not terribly good at determining, one of those ways will work quite often, one will work some of the time, and the other will be a disaster... but there's an equal probability that each of those ways are equally likely to fall in to each of those categories. Statistically, one could claim that how you solve the problem is not behind the success. In a sense, that would be correct, because the real determinant of success would be being lucky with the solution you chose to employ. While one could imply though that really it's nothing more than being lucky at choosing the solution, in reality without all of what's involved in that choice, the problem will remain.
pdabbadabba|1 year ago
Other kinds of conditions, like depression and anxiety, respond to a wider range of therapy styles. But those aren't the only conditions that people seek to treat through talk therapy. (And it's also an exaggeration to say that just having any conversation will help to treat anxiety and reopression. But it is probably true that treatment of these conditions is less technical and responds to a much wider range of styles.)
burnte|1 year ago
This isn't true. Different methods work better for different problems. I've been in behavior health for 7 years now. It's having someone with a lot of education to talk to, someone with education in social and psychological problems and healthy coping mechanisms.
lo_zamoyski|1 year ago
pphysch|1 year ago
If you are fortunate, you have people like that in your immediate circle, but increasingly few people do.
pas|1 year ago
it's a bit more complicated than that
https://www.youtube.com/watch?v=Z37i8-FnAh8
and on top of this the method of therapy is to find better copings, not just to vent.
fatbird|1 year ago
This is largely due to a crisis in the field in the late 70s/early 80s when several studies demonstrated that talk therapy had outcomes no different than no therapy. In both cases, some got better, some got worse, some didn't change. CBT was a direct result of that, prioritizing and tracking positive outcomes, and from CBT came a lot of different approaches, all similarly focussed on being demonstrably effective.
Talk therapy isn't a cure-all, but it's definitely more results-oriented than it was 50 years ago.
naasking|1 year ago
cbsmith|1 year ago
There's no defined stop point for physical development either... Top performing athletes still have trainers, and nobody sees that as a problem. If it's mental development though, it must have a stop point?
jodrellblank|1 year ago
- Patient choosing a specific mood problem/feeling they want to work on.
- A mood survey, where the patient rates their own level of e.g. anxiety, depression, fear, hopelessness. (e.g. out of 5 or 10).
- Therapy session, following his TEAMS CBT structure. Including patient choosing how much fear they'd like to feel (e.g. they want to keep a little bit of fear so they don't endanger themselves, but don't want to be overwhelmed by fear, 5% or 20%, say).
- A repeat of the mood survey, where the patient re-assesses themselves to see if anything has improved. There's no units on the measures because it's self-reported, the patient knows if the fear is unchanged, a little less, a lot less, almost gone, completely gone, and that's what matters.
That gives them feedback; if there is improvement within a session they know something in the session helped, if several sessions go by with no improvement they know it and can change things up and move away from those unhelpful approaches in future with other patients, and if there is good improvement - patient is self-reporting that they are no longer hopeless about their relationship status, or afraid of social situations, or depressed, to the level they want, then therapy can stop.
He's adamant that a single 2hr session is enough to make a significant change in many common mood disorders[2], and this "therapy needs to take 10 years" is a bad pattern and therapists who don't take mood surveys and before and after every session are flying blind. With feedback on every session and decades of experience, he has identified a lot of techniques and ways to use them which actually do help people's moods change. I liken it to the invention of test cases and debuggers (and looking at the output from them).
[1] Quick list: https://feelinggood.com/list-of-feeling-good-podcasts/ more detailed database: https://feelinggood.com/podcast-database/
[2] no, internet cynic, obviously not everything and presumably not whatever it is you have.
fatbird|1 year ago
CBT and its derivatives very strongly attend to individual effectiveness and view therapy that goes on endlessly as a sign that the real problem isn't being addressed, and that no therapy is considered effective unless it ends. Individual therapists might be bad actors, but the field itself is now admirably focussed on finite, positive results.
bnralt|1 year ago
> then you should get another therapist
Seems to be fairly ubiquitous. “Find a therapist you like”/“shop around”/etc. leads a lot of people to find people who will tell them what they want to hear. Sometimes what people want to hear is how to practice CBT - but in that case, such people are probably going to be using AI to work on CBT.
helboi4|1 year ago
moralestapia|1 year ago
I do think therapists are one of the professions that will be naturally displaced by LLMs. You're not paying them to be your friend (and they are usually very clear on that), so any sort of emotional connection is ruled out. If emotions are taken away, then it's just an input/output process, which is something LLMs excel at.
fatbird|1 year ago
Put another way, a good therapist is professionally trained and consciously monitoring whether or not they're misleading you. An LLM has no executive function acting as a check on its input/output cycle.
solardev|1 year ago
When I was younger, I went through many therapy sessions with multiple professionals of different kinds (psychologists, psychiatrists, MFT (marriage and family therapists, social workers, etc.).
A couple of them were wonderful: thoughtful, caring, helpful, providing useful guidance with a compassionate ear.
Another couple tried to be helpful but were still in training themselves (this was at a college) and couldn't really provide any useful guidance.
One was going through a divorce of her own at the time and ended up crying in many of our sessions and having to abort them to deal with her own emotions – it was a tough time for her, and she's only human. I often tried to console her, but she wouldn't let me, so it made for a very awkward situation lol.
One of them had one a single session with me, charged me for it, and then told me she couldn't help me and to go somewhere else.
But the worst of them was an older guy who, despite the referrals and my history, thought I was faking mental illness. He dared me to attempt suicide, and when I eventually did (not because of him, but a separate romantic failure), he chuckled in my face and said, "Heh, you finally tried it, huh? Didn't think you would." This was an older psychiatrist in a small town – either the only one there, or one of very few – the kind of sleazy place that had a captive market and a whole bunch of pharma ads in the lobby, with young female pharma reps going in and out all day. What a racket =/ If I were wiser then, I would've reported him to the board and news media.
So, anecdotally, my success rate with therapists was only 2/7. To be fair, I was a pretty fucked up teenager and young adult, but still... the point is that "just find a better therapist" is often a difficult process. Depending on your insurance and area, there may not even be any other therapists with a waiting list of less than a few months, and even if you can get in, there's no guarantee they are good at their jobs AND a good fit for your personality and issues.
Think it's hard to find good devs? At least our line of work produces some measurable output (software/apps that run, or not, according to specs). How do you even measure the output of a therapist? Improvements to someone's life aren't going to happen overnight, and many never report back; the best successes may not bother to leave a review, the worst failures may end up dead before spreading the word. The rest probably just run out of sessions allowed by their insurance and try to move on with their lives, with unknown levels of positive or negative change.