the study's conclusion, if i'm reading it right, is that therapy is associated with a tendency in people toward fewer good traits and more bad traits. an interesting result given how often therapy is recommended as helpful.
study seems to have used some kind of matched pair design. maybe there's something to this...
Therapy involves lots of talking while life happens. It isn't magic. Sometimes life just sucks for people. Sometimes it's hard on people. Good traits and bad traits put a fuck ton of a huge burden on individuals. There's the whole world. The world affects all people, regardless of whether you know how to see how it does.
Interesting results (thanks for the SciHub link), but also a call for more research. Not enough info yet to rule out a likely explanation: that those who seek therapy were already in a negative situation, and thus the therapy is a symptom of a problem rather than the cause of one. They discuss additional interesting angles about it near the end, re therapists who don't follow standard protocols, patients who don't stay with therapy, etc.
As this appears to be about measuring statistical association, and not just singling out individual failure cases, are you implying that the entire industry is generally filled with unskilled and dishonest people?
Edit: It was an honest question, and it does appear to be considered an untrustworthy profession as a whole here. I was just asking clarification if that was the intention of the parent poster.
There's an information imbalance. A lot of people have access to lots of stuff that can tell them how to live their life better. They have access to information about psychology, about how their brain works. They have access to information that in endless varieties of ways, can 'hack' their brain, change them.
1. This doesn't make people happy. Constantly trying to fix yourself is like running past the goal post as soon as you get there.
2. Life just sucks sometimes, and therapy doesn't always make it better. You can't force a therapist to actually have compassion and empathy for someone if they don't. This may be complicated. Therapists and stuff may have their own issues, like the fact that they have to deal with a world where everyone has access to almost the same information they do. How can they help? How can they deal with a dynamic where a mentally ill person may even understand this, and have compassion for it? That has to be confusing.
The world is crazy and there are no rules. We want to believe there are rules when there is chaos, but there aren't. Sometimes you just have to trust people. That can be really scary if you don't know them, and it can also be really scary if you've been educated into a career where you are constantly on the lookout for people that could be ... dangerous.
Also culture. There's a fuck ton of stigma going around for mentally ill people lately. Just because we were more aware of it a couple of years ago doesn't mean it improved collectively. We've taken a massive step backwards culturally when we blame every horrible thing that happens in the world on mentally ill people. That's all in the cultural background noise, it changes things, affects the ways people see things, affects their fears. We are not omnipotent beings that know everything.
Some information that people with fucked up intentions intend on spreading for whatever intent - you gotta fight it. If you don't, it's going to hurt you in the long run. That's something I've learned through lots of confusion.
My experience tends to confirm this. I have had two personal therapists, one was of the "Why do _you_ think you feel that way?" ilk with some kind of counseling certification, and the other was an evidence-based practitioner with a PsyD. The former didn't help me at all and the latter changed my life.
My wife and I saw two couples therapists. One was, again, a guy with some kind of certificate that did things like literally pulling the Good Will Hunting "It's not your fault. It's not your fault." hand-on-knee line as well as outright verbally attacking my wife. The other was a PsyD who made more progress with us in three sessions than almost a year of sessions with the other.
The crux of it all, in my estimation, is that you get what you pay for. A PsyD having a doctorate can command hundreds per hour which puts them out of range for many people.
If you have a bacterial infection, a relatively incompetent doctor giving you an antibiotic is going to do you a lot more good than the world's best homeopathist. The question then is whether therapy is more like medicine or more like homeopathy. This study suggests it might actually be worse than homeopathy which at least doesn't appear to cause worse outcomes than doing nothing.
This was longitudinal study where people who chose to go to therapy were compared to those who didn't chose to go, not a randomized experiment with a control group.
Here's a link that gets you a pdf, I recommend reading the general discussion.
People who choose to go to therapy probably tend to generally feel more negative feelings (and express them) than people that don't. Is this study anything more than pointing out that obvious correlation? I don't see how they can demonstrate causation without randomizing with a control group.
My understanding is that the study looked at change over time, so it's not as badly designed a study as a simple correlation, though it is still not ideal.
Well, I mean an obvious correlation isn't necessarily real or proven until you measure it, so this isn't nothing, but it's not what I think people saw when the read the title, which was evidence that therapy itself lead to worse outcomes.
Also: did therapy cause these apparently increases in negative characteristics or unmask them? It's possible that after therapy people were less in denial about their actual feelings.
Overall it seems like a fairly shallow study, though it does raise questions.
Common sense would say young adults with negative personality are more likely to start therapy. Logic says correlation does not equal causation. The authors argument about their renegade research/analysis, is not persuasive as to why correlation equals causation within the scope of their longitudinal analysis.
I agree that correlation does not equal causation, but I wonder if that, reframed, is actually a reason why therapy can be harmful. Therapy tends to treat negative thoughts as things caused by events and/or other thoughts, and this itself may be a pernicious way of mistaking correlation for causation. I think a fair amount has been written about how harmful therapy is when applied to people with serious mental illnesses, because it encourages people to dwell on negative thoughts and come up with spurious and unhelpful reasoning about causality. But if it doesn't work in the most severe circumstances, why should we remain committed to the belief that it works in less severe ones?
Plus medication was one of the treatments under "therapy" in this study - and there's serious doubt whether medication(in general) is helping or harming.
A lot of beliefs are neither true nor false, but rather "self-fulfilling". If you believe that you lack the ability to succeed professionally, you aren't going to put in the effort to try, which means you won't succeed. If you believe you're fundamentally unlovable, you will shy away from trying to connect with other people, because it just means you'll be rejected and hurt anyways. If you believe everyone is out to get you, you'll behave in a self-interested and paranoid way, which will scare off anyone who just wants to help so that everyone remaining really is out to get you. If you believe therapy is completely unhelpful, you won't listen to anything the therapist says and so it will be unhelpful.
The role of therapy is usually to break these "causality loops" by first introducing the idea that there is another possible way of interpreting these perceptions, and secondly asking the patient "Well, what kind of life do you want to have, and how can you get there?" A good therapist doesn't encourage people to dwell on negative perceptions; rather, they should be encouraging you to acknowledge the thought, and then also come up with other possible framings, explore what you really want, and act on that.
Causality vs. correlation is somewhat immaterial: the point is that your cognition is both a reflection of the world as it is and a driver for how you would like it to be, and so it functions as a feedback loop. If you're getting good results in your life it's a good feedback loop, but if something is wrong and you haven't been able to fix it, it can be helpful to have a trusted outsider who can point out your unspoken assumptions.
This assumes a best case scenario and a good therapist. When it works, it's a good thing.
But you can't ignore the fact that therapists are people too and may be injecting their own bullshit into the equation rather than helping the person sort their own crap out of the equation.
I mean, I upvoted you and I think it's a good comment, but I have had lots of serious personal problems where other people wanting to "help" was really other people wanting to insist on keeping me down and expecting me to be grateful for it. Many of the more well meaning types wanted to help me, but not enough that I could genuinely stand on my own two feet. They wanted metaphorically get me out of the wheelchair and walking, but they wanted me to always need a crutch so that they could be needed because they needed to be needed or they couldn't imagine anyone could genuinely love them or want to friends if they weren't desperately needed by someone who couldn't cope on their own.
"Well, what kind of life do you want to have, and how can you get there?"
You sound like someone who believes in the power of positive thinking. I think if you wouldn't use your concepts of feedback loops in thinking to sober a drunk up and shove them in a car, you shouldn't consider them appropriate therapy for any other mental state.
> A lot of beliefs are neither true nor false, but rather "self-fulfilling". If you believe that you lack the ability to succeed professionally, you aren't going to put in the effort to try, which means you won't succeed.
This isn't true. Satisfactory work is not always affected by perception or quantity of work (someone may be doing good work and thinking it's poor; someone's hard work can be another's easy work; someone can do a lot of quality work without huge effort). Quite a few successful people with imposter syndrome and depression exist. People don't have super powers in terms of causality. What people think or "think" often doesn't matter that much and it's rather dangerous to give it so much gravity. This is far more gravity than the individual themselves gives their thoughts.
> If you're getting good results in your life it's a good feedback loop, but if something is wrong and you haven't been able to fix it
The problem is this describes an incredibly linear, just-world model of reality. I.e., if someone is getting good results in their life, it's due to them. If someone is getting bad results in their life, it's due to them. There's no room for randomness here, while in reality our world is very random, and people may be getting very random results and assigning them all sorts of wrong causalities.
It's really going to be a rather lousy therapist not realizing this and blaming some patient for reacting to some trauma. People's weird loops are often just adaptations to the random, erratic, and unfair world around them.
> If you believe therapy is completely unhelpful, you won't listen to anything the therapist says and so it will be unhelpful.
Well, that's useful, given that despair is pretty common in depression, one of those illnesses people go get therapy for. Good thing this isn't true, and people absolutely can be pulled out of ruts by random outside events or by well-placed conversation. I would say therapists are not very useful if they can't do something as simple as pull a person out of a standard "everything sucks and will always suck" loop.
" if someone is getting good results in their life, it's due to them. If someone is getting bad results in their life, it's due to them."
It's not that it's due to them, it's that this is the only part they can control. Luck & randomness happens. Over the course of a lifetime it usually averages out for a given person - that's why we call it luck.
But for some people, instances of bad luck can set them off into a downward spiral that prevents them from taking advantage of instances of good luck later, while other people shrug off the bad things and take full advantage of lucky opportunities later. You can't control what happens to you, but you can control how you react to it.
One of the skills that therapy, done right, teaches is being able to recognize what's realistically in your control and what's not, and then not paying too much attention to what's out of your control.
Let's think about personality traits in a depressed person:
Extraversion: "leave me alone"
Agreeableness: "the world is shit"
Conscientiousness: "my home is a mess"
Openness: "Why try something new if I know I'm not going to like it"
Conscientiousness: "my home is a mess"
People who go through these phases, or live in this reality, are more likely to have seeked therapy. The results could imply that, after all, it is not very effective, since it is observed that "Therapy experience is associated with negative changes in personality", but to make the analogy clear, you could say: "People with heart transplants see reduction of heart function".
I have anecdotally experienced this, among other more measurable negative outcomes of therapy. My experience was in America, which as I understand has a similar psychology industry to most European countries, albeit the extra double dose of exceptionalism, rigidity, and economic depravity one would expect.
Misdiagnosis was the worst part of my experience, but not the beginning or the end. Diagnoses are naturally a double edged sword and some therapists avoid them altogether, but it seems a clear mistake to focus on this conflict.
Bureaucracy notwithstanding, a lot of the reason for diagnoses is that the suffering seek closure. I declare however that a lot of the reason for the mental health field is that the citizens of a suffering society seek closure. The therapist delivers that closure in the form of: “It’s you.” Whether this contributes something wholly productive to that person’s mental health is surely circumstantial. For me, it was a disaster.
I’m not comfortable making similarly broad assertions about therapy itself, but in my experience, it was just me opening up to someone who didn’t open up to me. Having a 3rd party to resolve disputes is not any new invention so couple therapy and similar should probably be considered separately. As for individual therapy, I have been inable to map the process by which what we call therapy today evolved from what was psychoanalysis. My fear is that it was painfully basic and painfully stupid. Can someone fill me in?
Some of my friends are in the mental health field and a couple of them are very open minded, willing to discuss these things. Our conversations led me to make a vow that I will never visit another mental health professional for as long as I live. Being no stranger to the history and other less contempory criticisms of psychology, the experience motivated me to learn more about the industry of psychology in America. I think the issues are strikingly congruent with contextual issues in the structures that empower it. In the US, this would be law enforcement, healthcare, academia, public education, the economy. In a sum, I concluded that capitalism is simply not as fit to address mental health problems as it is to create them.
From my own experience, therapy was only the first step. It wasn't the solution. The further I went down the path (more than 10 years on my own, couples therapy for over a year with my ex-wife, and two separate one week intensive experiential retreats) the less helpful it was. After doing work with a Zen coach, meditating regularly and going on a ten day silent meditation retreat what became clear to me is that therapy tends to drag one's focus back to what happened in the past to explain the present. I think therapy has a place. I think it would be exceedingly difficult to create a valid study that proves what this piece claims.
In one study of treatment-as-usual for drug and alcohol disorders, the researchers found that most therapists failed to implement well-validated intervention techniques (Santa Ana et al., 2008), choosing instead to focus on assessing social functioning and asking open-ended questions, rather than changing relevant thoughts, feelings, or behaviors.
This is what stood out to me and seems similar to problems I hear regarding internal medicine. Doctors trust their intuition above results of novel studies. It takes time for their recommendations to catch up.
Edit: The authors of the study don't imply causation, but it's tempting to infer it yourself. Thus, my comment.
OK. So this is a observation study, not an experiment. Only correlation can be inferred, not causation.
To make it clear why you can't, let me come up with a new, parallel study:
Track everybody who self reports being told they have a genetic disposition to cancer by a doctor. Divide them by those that decide to go a cancer treatment center vs those who don't. The study would probably show that cancer treatment centers are associated with shorter lifespans.
That makes sense, because you're not going to go to a cancer center treatment if you don't have cancer. But it doesn't mean that going to a cancer treatment centers are ineffective.
Self selection in a study means you can't infer causation. You can only infer correlation.
Note: I'm not actually weighing in on whether I think therapy is good or bad. I'm say the results of this study could happen either way.
Edit: I think you could reasonably infer that therapy isn't enough whenever it is used. But you can't tell if not going to therapy would have been better than going to therapy for those who did - so if there's an action item from this study, it's to improve therapy. But I don't think you can unequivocally say: this study shows therapy is bad.
Let me start out by saying that although I am not a psychotherapist, I do have a masters in psychology, and two years graduate clinical training, plus experience in the field. I also have some experience helping conduct psychotherapy research studies.
Back in the 60, a well-known psychological researcher named Hans Eysenk published a claim that, based on an analysis of many psychotherapy outcome studies, psychotherapy does not work. This sparked a great debate.
I was puzzled by this claim, since it seemed clear to me that psychotherapy could be helpful. But then years later I read an article in the Handbook of Psychotherapy and Behavior Change, I think it was the 1979 edition.
It was written by Truax and Carkhuff, and it summarize a number of studies that looked at outcome by psychotherapist. What they found was that about 1/3 of psychotherapists were helpful with most of their clients, 1/3 had little impact, and 1/3 were on the whole harmful.
Based on a good deal of experience in the field, including a whole summer observing psychotherapists practicing group psychotherapy in a mental health clinic, this seemed to me about right.
I think the problem started with Freud. He was a brilliant man in many ways, but I think it is clear he was not very good at actually curing people of their personal problems. In the decades that followed, I think there was a pattern that developed where some training institutes, Freudian and non-Freudian, were run by therapists who are poor at the craft and so don't know how to teach it to others, and furthermore don't know how to select students who would be good therapists, while at other institutes the overall pattern was neutral or positive.
I have been out of the field for many decades, and had hoped things had improved. Alas, it seems that is not the case.
43 comments
[ 2.8 ms ] story [ 83.7 ms ] threadstudy seems to have used some kind of matched pair design. maybe there's something to this...
The unskilled will make a mess of what they are given out of incompetence.
The dishonest will make a mess of what they are given out of greed and malice.
Sadly, in this case, the one suffering the consequences is not a car or some code but a person.
Edit: It was an honest question, and it does appear to be considered an untrustworthy profession as a whole here. I was just asking clarification if that was the intention of the parent poster.
1. This doesn't make people happy. Constantly trying to fix yourself is like running past the goal post as soon as you get there.
2. Life just sucks sometimes, and therapy doesn't always make it better. You can't force a therapist to actually have compassion and empathy for someone if they don't. This may be complicated. Therapists and stuff may have their own issues, like the fact that they have to deal with a world where everyone has access to almost the same information they do. How can they help? How can they deal with a dynamic where a mentally ill person may even understand this, and have compassion for it? That has to be confusing.
The world is crazy and there are no rules. We want to believe there are rules when there is chaos, but there aren't. Sometimes you just have to trust people. That can be really scary if you don't know them, and it can also be really scary if you've been educated into a career where you are constantly on the lookout for people that could be ... dangerous.
Also culture. There's a fuck ton of stigma going around for mentally ill people lately. Just because we were more aware of it a couple of years ago doesn't mean it improved collectively. We've taken a massive step backwards culturally when we blame every horrible thing that happens in the world on mentally ill people. That's all in the cultural background noise, it changes things, affects the ways people see things, affects their fears. We are not omnipotent beings that know everything.
Some information that people with fucked up intentions intend on spreading for whatever intent - you gotta fight it. If you don't, it's going to hurt you in the long run. That's something I've learned through lots of confusion.
My wife and I saw two couples therapists. One was, again, a guy with some kind of certificate that did things like literally pulling the Good Will Hunting "It's not your fault. It's not your fault." hand-on-knee line as well as outright verbally attacking my wife. The other was a PsyD who made more progress with us in three sessions than almost a year of sessions with the other.
The crux of it all, in my estimation, is that you get what you pay for. A PsyD having a doctorate can command hundreds per hour which puts them out of range for many people.
I wouldn’t be so sure https://arstechnica.com/science/2017/09/cdc-homeopathic-heal...
Here's a link that gets you a pdf, I recommend reading the general discussion.
https://scholar.google.com/scholar?q=Therapy%20experience%20...
Overall it seems like a fairly shallow study, though it does raise questions.
Plus medication was one of the treatments under "therapy" in this study - and there's serious doubt whether medication(in general) is helping or harming.
The role of therapy is usually to break these "causality loops" by first introducing the idea that there is another possible way of interpreting these perceptions, and secondly asking the patient "Well, what kind of life do you want to have, and how can you get there?" A good therapist doesn't encourage people to dwell on negative perceptions; rather, they should be encouraging you to acknowledge the thought, and then also come up with other possible framings, explore what you really want, and act on that.
Causality vs. correlation is somewhat immaterial: the point is that your cognition is both a reflection of the world as it is and a driver for how you would like it to be, and so it functions as a feedback loop. If you're getting good results in your life it's a good feedback loop, but if something is wrong and you haven't been able to fix it, it can be helpful to have a trusted outsider who can point out your unspoken assumptions.
But you can't ignore the fact that therapists are people too and may be injecting their own bullshit into the equation rather than helping the person sort their own crap out of the equation.
I mean, I upvoted you and I think it's a good comment, but I have had lots of serious personal problems where other people wanting to "help" was really other people wanting to insist on keeping me down and expecting me to be grateful for it. Many of the more well meaning types wanted to help me, but not enough that I could genuinely stand on my own two feet. They wanted metaphorically get me out of the wheelchair and walking, but they wanted me to always need a crutch so that they could be needed because they needed to be needed or they couldn't imagine anyone could genuinely love them or want to friends if they weren't desperately needed by someone who couldn't cope on their own.
You sound like someone who believes in the power of positive thinking. I think if you wouldn't use your concepts of feedback loops in thinking to sober a drunk up and shove them in a car, you shouldn't consider them appropriate therapy for any other mental state.
This isn't true. Satisfactory work is not always affected by perception or quantity of work (someone may be doing good work and thinking it's poor; someone's hard work can be another's easy work; someone can do a lot of quality work without huge effort). Quite a few successful people with imposter syndrome and depression exist. People don't have super powers in terms of causality. What people think or "think" often doesn't matter that much and it's rather dangerous to give it so much gravity. This is far more gravity than the individual themselves gives their thoughts.
> If you're getting good results in your life it's a good feedback loop, but if something is wrong and you haven't been able to fix it
The problem is this describes an incredibly linear, just-world model of reality. I.e., if someone is getting good results in their life, it's due to them. If someone is getting bad results in their life, it's due to them. There's no room for randomness here, while in reality our world is very random, and people may be getting very random results and assigning them all sorts of wrong causalities.
It's really going to be a rather lousy therapist not realizing this and blaming some patient for reacting to some trauma. People's weird loops are often just adaptations to the random, erratic, and unfair world around them.
> If you believe therapy is completely unhelpful, you won't listen to anything the therapist says and so it will be unhelpful.
Well, that's useful, given that despair is pretty common in depression, one of those illnesses people go get therapy for. Good thing this isn't true, and people absolutely can be pulled out of ruts by random outside events or by well-placed conversation. I would say therapists are not very useful if they can't do something as simple as pull a person out of a standard "everything sucks and will always suck" loop.
It's not that it's due to them, it's that this is the only part they can control. Luck & randomness happens. Over the course of a lifetime it usually averages out for a given person - that's why we call it luck.
But for some people, instances of bad luck can set them off into a downward spiral that prevents them from taking advantage of instances of good luck later, while other people shrug off the bad things and take full advantage of lucky opportunities later. You can't control what happens to you, but you can control how you react to it.
One of the skills that therapy, done right, teaches is being able to recognize what's realistically in your control and what's not, and then not paying too much attention to what's out of your control.
Extraversion: "leave me alone"
Agreeableness: "the world is shit"
Conscientiousness: "my home is a mess"
Openness: "Why try something new if I know I'm not going to like it"
Conscientiousness: "my home is a mess"
People who go through these phases, or live in this reality, are more likely to have seeked therapy. The results could imply that, after all, it is not very effective, since it is observed that "Therapy experience is associated with negative changes in personality", but to make the analogy clear, you could say: "People with heart transplants see reduction of heart function".
Misdiagnosis was the worst part of my experience, but not the beginning or the end. Diagnoses are naturally a double edged sword and some therapists avoid them altogether, but it seems a clear mistake to focus on this conflict.
Bureaucracy notwithstanding, a lot of the reason for diagnoses is that the suffering seek closure. I declare however that a lot of the reason for the mental health field is that the citizens of a suffering society seek closure. The therapist delivers that closure in the form of: “It’s you.” Whether this contributes something wholly productive to that person’s mental health is surely circumstantial. For me, it was a disaster.
I’m not comfortable making similarly broad assertions about therapy itself, but in my experience, it was just me opening up to someone who didn’t open up to me. Having a 3rd party to resolve disputes is not any new invention so couple therapy and similar should probably be considered separately. As for individual therapy, I have been inable to map the process by which what we call therapy today evolved from what was psychoanalysis. My fear is that it was painfully basic and painfully stupid. Can someone fill me in?
Some of my friends are in the mental health field and a couple of them are very open minded, willing to discuss these things. Our conversations led me to make a vow that I will never visit another mental health professional for as long as I live. Being no stranger to the history and other less contempory criticisms of psychology, the experience motivated me to learn more about the industry of psychology in America. I think the issues are strikingly congruent with contextual issues in the structures that empower it. In the US, this would be law enforcement, healthcare, academia, public education, the economy. In a sum, I concluded that capitalism is simply not as fit to address mental health problems as it is to create them.
This is what stood out to me and seems similar to problems I hear regarding internal medicine. Doctors trust their intuition above results of novel studies. It takes time for their recommendations to catch up.
OK. So this is a observation study, not an experiment. Only correlation can be inferred, not causation.
To make it clear why you can't, let me come up with a new, parallel study:
Track everybody who self reports being told they have a genetic disposition to cancer by a doctor. Divide them by those that decide to go a cancer treatment center vs those who don't. The study would probably show that cancer treatment centers are associated with shorter lifespans.
That makes sense, because you're not going to go to a cancer center treatment if you don't have cancer. But it doesn't mean that going to a cancer treatment centers are ineffective.
Self selection in a study means you can't infer causation. You can only infer correlation.
Note: I'm not actually weighing in on whether I think therapy is good or bad. I'm say the results of this study could happen either way.
Edit: I think you could reasonably infer that therapy isn't enough whenever it is used. But you can't tell if not going to therapy would have been better than going to therapy for those who did - so if there's an action item from this study, it's to improve therapy. But I don't think you can unequivocally say: this study shows therapy is bad.
You shouldn't remove something so relevant from the title.
Let me start out by saying that although I am not a psychotherapist, I do have a masters in psychology, and two years graduate clinical training, plus experience in the field. I also have some experience helping conduct psychotherapy research studies.
Back in the 60, a well-known psychological researcher named Hans Eysenk published a claim that, based on an analysis of many psychotherapy outcome studies, psychotherapy does not work. This sparked a great debate.
I was puzzled by this claim, since it seemed clear to me that psychotherapy could be helpful. But then years later I read an article in the Handbook of Psychotherapy and Behavior Change, I think it was the 1979 edition.
It was written by Truax and Carkhuff, and it summarize a number of studies that looked at outcome by psychotherapist. What they found was that about 1/3 of psychotherapists were helpful with most of their clients, 1/3 had little impact, and 1/3 were on the whole harmful.
Based on a good deal of experience in the field, including a whole summer observing psychotherapists practicing group psychotherapy in a mental health clinic, this seemed to me about right.
I think the problem started with Freud. He was a brilliant man in many ways, but I think it is clear he was not very good at actually curing people of their personal problems. In the decades that followed, I think there was a pattern that developed where some training institutes, Freudian and non-Freudian, were run by therapists who are poor at the craft and so don't know how to teach it to others, and furthermore don't know how to select students who would be good therapists, while at other institutes the overall pattern was neutral or positive.
I have been out of the field for many decades, and had hoped things had improved. Alas, it seems that is not the case.