Recall, the "reproducibility crisis" came to everyone's attention because of how bad the papers from these two camps were. Nothing really changed, no one got fired, and the situation, seems to have not only not improved but the quality has gone DOWN.
Maybe the law should be they have to wear the hats till they un fuck the last 30 years of publishing...
The phone rings, your family just got crushed by a runaway truck.
The phone rings, the company you founded and spend every waking hour of the last four years has a hostile take-over. They are firing you and you find out that the structure of the shares is in such a way that you walk away with peanuts.
The phone rings, your mother is in de hospital, she will probably die before next dawn. You are six thousand miles away.
I mean, you are probably a very stable genius at the moment, but not everybody is and you might not be that for ever. Things can change. If your endocrine system gets a hit somewhere and you get hit by this kind of news. You probably will go into a bad place.
I know someone who was severely dehydrated from a viral infection, got into a delirium, then had to recover for 6 years, and still is not the same now.
Asserting that anything bad will push people into breakdown, psychosis, is plain wrong.
Bad things happen to almost everyone some of the time. Do you see nearly all of the people on the planet broken down, pshychotic? If you do, I think the problem is with the observer.
Most people are sane despite dealing with bad stuff, which proves the assertion wrong.
OMFG, people! Therapy isn't pseudoscience. There is a shitload of evidence that it works. You don't get to wave around the reproducibility crisis like it's a magic wand to make things that scare you go away. Now show me on the doll where therapy hurt you.
As "verified" not by hard measurements (like in Physics), proofs (as in math), or specific clinical results (e.g. blood panels in medicine) but with questionaires and "assessments" by the very people whose continued existance and esteem of the field their careers are based on?
"All kinds of evidence that it works" was there for Freudian psychanalysis too.
That's true for most science though, biology had the same issues earlier in the 1800s-1900s until the field matured. It doesn't mean that all biology from that time was pseudoscience, it was wrong but paved the way to find the right answers.
Psychology has its successes, empirically proven by getting results in clinical settings, we don't have deep answers on why some of it works or not but working known pharmaceutical compounds also suffer from that, we know they work but we don't know how (some NSAIDs come to mind, psychiatric meds, anesthesia as well).
> ... in 1952 in which H. J. Eyesenck, an English psychiatrist, divided thousands of World War II veterans hospitalized for mental illness into three groups. One group was treated by psychoanalysis, another was given other kinds of therapy, and the third received no treatment at all. The men were then measured on an "improvement scale" with these stunning results: 44 per cent improved with psychoanalysis, 64 per cent improved with other therapies, and 72 per cent got better with no treatment at all.
> More recently, Werner Mendel, professor of psychiatry at the University of Southern California, directed a similar study. Trained psychoanalysts treated the patients in the first group, less highly trained psychologists and psychotherapists treated the second group, and the third group was under the care of employees with no formal training. The improvement ratings showed the following remarkable results: the third group, treated by staff members without formal training in therapy, showed the most improvement, whereas the first group, treated by staff members with the most extensive training in psychotherapy, showed the least improvement. Understandably, Dr. Mendel was startled by the results and repeated the experiment, with the same outcome.
Now, I'm not going down this rabbit-hole (I did once and wasted a lot of time!) but there is a lot of evidence that just a bit of attention from another person may be helpful, and affective attention may work wonders.
Which behaviors are reinforced more than a general level of consideration and positive regard?
I hadn't heard of this study. I had heard that the case count for psychoanalytic psychotherapy was insufficient to fairly cluster by symptoms as (e.g. hierarchical) features, even. And then Milgram's selection bias.
Is all "Talk Therapy" bad then, and what's a good way to actually help;
> Clean language offers a template for questions that are as free as possible of the facilitator's suggestions, presuppositions, mind-reading, second guessing, references and metaphors. Clean questions incorporate all or some of the client's specific phrasing and might also include other auditory components of the client's communication such as speed, pitch, tonality. Besides the words of the client, oral sounds (sighs, oo's and ah's) and other nonverbals (e.g. a fist being raised or a line-of-sight) can be replicated or referenced in a question when the facilitator considers they might be of symbolic significance to the client.
> The questions containing the verb ‘to be’ help to keep time still and are mostly used for developing individual perceptions:
> Questions containing the verb ‘to happen’ generally encourage the client to move time forwards or backwards:
> Questions which utilise other verbs are:
A prompt: Leadership and Public Speaking: which can utilize Clean Language; and which are necessarily suggestive of direction, course, or sequalae of events?
> there is a lot of evidence that just a bit of attention from another person may be helpful, and affective attention may work wonders
Anecdotally, this matches my second-plus-hand observations. In particular, professional "caring" is seen as clinical curiosity (at best) and less authentic, whereas ordinary-person empathy is more meaningful even in small doses.
Relatedly, addicts who seek traditional addiction therapy (anecdotally and second-plus-hand observationally) become lifetime (so far) addicts in how they perceive themselves, even if they quit the substance/behaviour. This tends to have a depressive effect. Addicts who make other changes in their lives which break the addictions have a more reflective view of the different times of their lives (non-addicted, addicted, then non-addicted again), and appear happier.
Addiction and depression are complicated things which I do not have any special knowledge of personally! However, I have varying adjacencies to many people with more complicated lives than my own. I share these anecdotes only because the observations are stark and seem important.
Its still going, but not in public research institutes. It didn't go out of fashion - it couldn't deliver on the demands for quantitative evidence in modern clinical medicine. That modern psychology now has it's own problems just goes to show how much psychoanalysis is a genre of literature and not much more.
Its weird that we are arguing this. The shift is well covered over the last half a decade. Also whats the point of lots of psychoanalytic papers being published? There exists a ton of string theory papers. Theology is a huge field, once the biggest academic discipline. Bullshit exist, so what.
I have a family member where my whatsapp history is a direct and concrete measure of their improved welfare after starting therapy: Our live conversations have largely been me dealing with the effects of OCD. Once they started therapy, the length of those conversations declined dramatically and rapidly, and while they still have some symptoms they are dealing with them far better.
You could argue it's a coincidence, but it'd seem a highly unlikely one given the therapy was specifically to address that OCD, and the techniques they're using to reduce the frequency were taught by the therapist. And of course it is one anecdote.
I have no doubt there are lots of people for whom therapy is insufficient or doesn't work, but there are also people for whom you can measure the effects in a lot of other ways than the judgment of therapists themselves.
What's contested is not that some therapist or therapy sessions ever helped people.
It's that it's scientific and systematic (and not e.g. arbitrary and subjective, whose efficacy is based on methodology but on the specific patient, the specific therapist, their rapport, and such things).
Talking to a friend also helped many a person overcome psychological problems. As did getting a new job, working out, getting laid, and lots of other things. None of those things claim to be scientific fields though.
>Care to enlighten us on a better way? We have people who need help right now, not when (or even if) we find some sort of objective test.
Doesn't mean they are getting help. Just means we set up a whole cargo cult field from thin air and on thin premises, and make-pretend we help them.
Meanwhile, more important structural changes to get them help, are of course ignored, because they are bad for bussiness or inconvenient (like better work-life-balance, less stressful educational/work/healthcare/late life prospects, more cohesive communities, better access to nature, less advertising and rage bait, and anything that doesn't help with the corporate mills grinding on).
I think it's well known -- and supported by evidence -- that personality, chemistry and rapport with the therapist matter more than the specific kind of therapy. (With some exceptions; for example, cognitive-behavioural therapy is specifically better suited for OCD than other modalities such as psychodynamic therapy are, while CBT alone probably isn't a good fit for severe trauma. AFAIK these are backed by evidence.)
So the specific theoretical frameworks aren't really scientific, at least for the most part. But you can do research on stuff such as whether outcomes are on the average better than without therapy, or whether modality or individual therapists matter more.
Of course the evidence is largely still from the questionnaires, with all of their problems, but the questionnaires aren't necessarily administered by the people giving the therapy so it may not be as biased as you might think.
It's no more scientific to reject evidence only because it is subjective.
For a whole lot of psychological conditions that do not get to the extremes the only reasonable assessment we can do is whether the patient feels there is a problem, or exhibit indicators of distress in relation to the problem.
Are you washing your hands so much it is OCD and a problem, or is it just a preference? At the margins - if you e.g. do it so much your hurt yourself - it becomes possible to argue it is objective, but for most people the answer purely comes down to whether or not it is subjectively a problem to them.
That does not mean we can not systematically measure whether people report an improvement under varying conditions and using varying methods.
It doesn't really matter if it is subjective - when the problem is that the patient feels there is a problem, then if the patient no longer reports feeling a problem, then unless you're prepared to assume that they are all in denial or lying, that is evidence of improvement even if it does not raise to the standard of evidence we would prefer.
It would be unreasonable to overstate what that means, but equally unreasonable to pretend it provides no signal in the absence of higher standard evidence unless you can identify specific problems (lack of ability to reproduce would be one).
I don't believe it's 100% true for all therapies. CBT works exactly as you describe, although it's efficient only for specific problems. There might be other therapies I don't know about which are equally clinically tested as CBT.
I'm sorry but this is a classic example of experts in one field (assuming CS by virtue of posting on Hacker News) assuming that they know anything worth saying about another field. There actually is a mountain of quantitative outcome research across therapy approaches. It's readily readable in metastudy form on Google Scholar and elsewhere.
>I'm sorry but this is a classic example of experts in one field (assuming CS by virtue of posting on Hacker News) assuming that they know anything worth saying about another field.
Or maybe it's just a classic example of a pseudo-field?
>There actually is a mountain of quantitative outcome research across therapy approaches
"Quantitative outcomes" for non-quantifiable conditions means "numerical statistics on answers in questionaires" and such.
>It's readily readable in metastudy form on Google Scholar and elsewhere.
Ah, metastudies, that pinnacle of rigour. "We hastily surveyed 200 varying quality, full of methodological errors, non replicating for the most part, primary studies, and the field is totally a success".
Therapy isn't pseudoscience but the reproducibility crisis is real. There's also the issue that if you change a therapist, their approach to treating, diagnosing a condition will change. With modern medicine, we have tests and reports and doctor's don't've that much of a leeway on how they treat a condition. We have medical malpractice lawsuits when doctor's go out of line.
Like the parent mentioned, the reproducibility crisis didn't change anything, we also can't be sure how many doctors actually took these findings into account.
The point I'm trying to make is that it is really difficult to identify bad therapists. It'll take a while before it's reliable enough and that's okay, but therapy gets thrown around as an option like it is.
"I know you hear those voices, but unfortunately I have no way of corroborating whether the voices are actually a problem or not. Would you like this pamphlet on how physics understands your brain?"
I wonder if the fact that the amendment earned "unanimous approval in the senate” is what should really be concerning here. The idea seems clearly a joke but it was voted for by everyone in a senate split 27 Demoratcs/15 Republicans and headed for a house vote with a similar division (46D/24R). Does no one read what they are voting for?
The answer, of course, is that everyone sincerely agreed it would be beneficial to have the quacks wear wizard hats (to keep them from getting a big head)
They might have read it, thought it was funny, and approved it anticipating someone else blocking or vetoing it.
I mean, it's certainly true that lots of gigantic, complicated bills don't get read properly by politicians before voting on them. But this is about a paragraph and written in clear English, so you'd imagine it would have a good chance of getting read.
I suppose (and hope) the representatives figured that out themselves, and were simply going along in the same spirit - but one can't be sure, at least these days.
One of my thoughts is that legislatures need more money for staff. Executive branches have billions of dollars to hire experts on long term contracts. How many in house experts does a legislature have?
Maybe 100 years ago this would work, but the modern state is really complex, and the problems are really complex, because if they were easy they would be solved.
The amount of money that state and federal legislatures control is huge, My hunch is that if they spent more on extra staff, the increase in quality of legislation would provide enough economic benefits to cover the cost.
Isn’t this part of the benefit of lobbyists? Assume that every bill that goes before the legislature has someone who cares greatly (because if no one cared, it’s a problem that would have been solved beforehand), and you can guarantee at least two opposing viewpoints being represented by lobbyists, for “free” from the point of the legislative admin budget.
This is hilarious. Do you genuinely think this little of politicians? No, seriously. I know politicians are easy to dunk on, but do you genuinely think that this is the explanation? That this is even a likely explanation? They weren’t just, you know, having a laugh? This is out of touch, even for HN.
I believe it is totally the opposite. Every single one of the voters has read the bill and agreed unanimously on passing it through, because it makes a lot of sense. Modern psychology is a little better than astrology back in the day.
Psychology is yet to become a proper science, once it accepts proper scientific methods and discards the voodoo of past days.
Until then, hereby I vote for them to wear wizard hats in public!
I have always thought law makers should have their head in a guillotine when they pass legislation. That would hopefully give them an awareness of the seriousness of their work, and the gravity of potential consequences.
I think this is a great plot. However, to make it more interesting:
1) who or what controls the guillotine collars?
2) if you say something in an interview and your head doesnt leave your body. It must be true, right? RIGHT?!
3) at some point a few adversaries that are questioning the guillotine suddenly tell a lie or pass a bad law and get "Sepped" (the slang for head and body SEParation, i.e. your head gets chopped.).
4) going against the party is "objectively" a lie and all people who dont fall in line of "truth" get "Sepped"
5) a law gets passed where everybody wears a mandatory guillotine collar. "We are a Republic of truth! Do you have things to hide? Are you a liar? Then you must fear this law. Only the morally corrupt will fear this law! All true citizens of the Republic will welcome this law."
It's the premis of an old Dr Who arc. The planets leaders life is televised at all times, and they are subject to a continuous live electronic popular vote that's going on at all times. When it dips far enough they die and the next one in line takes over.
Some of this is a reflection of society not wanting to confront the challenges with mental health. We went from just dumping people in asylums and ignoring issues like PTSD, to acknowledging these things exist, but trying to push everything into therapy and psych evals.
I think at some point we'll have to acknowledge that pscyhology is a fuzzy field and it doesn't always have the correct answers and somehow balance that with but sometimes the experts are right.
The fuzzier the field, the wider avenue for corruption in the courtroom. Declaring someone competent based on the non objective whim of an "expert" can have major monetary consequences.
Our society (well, the US and increasingly Europe where I’m from) has put a lot of resources and effort into mental health, largely by following “expert” recommendations.
Tons of people are being treated for mental health, children are medicalised, employers offer mental health courses and insurance, people sharing experiences about burnout, language being changed to avoid offending people, …
Or more likely, the current approach just doesn’t work very well.
If everyone with a disease starts taking a medicine, and nobody gets better, it doesn’t mean the medicine causes the disease, despite the correlation. It just means the medicine doesn’t work.
But if, after the mass introduction of that medicine, the number of people with the disease skyrocketed, then there’s a decent likelihood the causality does actually go that direction.
With other treatments for diseases we always expect the incidence rate to decline — because the treatment works. If it stayed static or went up slightly, then the treatment doesn’t work (and you’re might have slightly higher rates due to new interest in the diagnosis). But huge increases…that’d not be good.
Right, I wrote the above comment in a way that implied I blame the experts; I didn't actually mean that, by first approximation my "most likely" belief is simply that experts don't help at all.
But it's not hard to come up with actual causal reasons why experts are actively making things worse:
1. if people have confidence in experts, they'll seek treatment from them, and forego other, potentially more effective, treatments (in this particular case: making and talking to friends, not therapists; prioritizing family, not shunning them; prioritizing community, not isolating; etc.)
2. experts make a living selling advice to patients, so it's in their implicit interest to keep having patients (either individually, not curing them, or society-wise, making more patients) (there's a lot of anecdata about "I asked a therapist how many patients they actually cured, and they looked at me bewildered")
3. I've seen some opinions, which echo mine, that experts seeking, reaffirming, and reminding patients of their "traumatic experiences" might hurt more than it helps (e.g. talking to therapist every week makes you re-live your traumatic experience; narrowing the definition of "consent" and convincing women they've been raped; convincing children they're trans (they used to be called "tomboys!"); in general marking fairly normal life experiences - job loss, job stress, death in family, etc. - as "traumatic" and "requiring therapy")
If experts were the problem, then it would be statistically obvious that people were worse after meeting experts or taking their advice, and better off before.
But, that gets the order reversed. People seek mental health treatment after they already have a problem, not before.
It's much more likely that widespread effects are the cause: pollution, social media, poverty, capitalism, racism, etc.
I think what GP might be saying is that there is some risk associated with therapy (e.g. https://www.psychologytoday.com/us/blog/insight-therapy/2020... —- not sure if it’s a good source but you can find plenty more with a search) and, if today we push therapy widely even for relatively minor issues, in those cases that would have fixed themselves with time it’s possible to get a negative outcome.
I'm not sure I follow your logic. What do you hypothesise to be the causal factor linking these things?
I think we could look to any number of things that could exacerbate mental health issues. Climate disasters, social alienation, rapid inflation, political disillusionment, patriarchy etc.
> I'm not sure I follow your logic. What do you hypothesise to be the causal factor linking these things?
Hypothetically? It's common for an industry to want to expand their market.
Imagine you're a big drug company, and you make decent profits selling drugs to treat shell-shocked soldiers returning from the front lines after losing limbs and seeing their buddies die right in front of them.
You look for ways to increase your sales and add to your profits. What if you could also sell your drugs to people who've been in bad car accidents? And to rape survivors? And to refugees fleeing from war? And to mothers who had particularly difficult births? And teens subject to severe bullying? What about cancer survivors, or people who've struggled following the death of a grandparent?
It's easy to see how higher diagnosis rates could go hand in hand with higher sales and higher profits.
> I imagine all of the people you listed would be suffering from mental health issues without the need for a conspiracy theory.
Maybe, but I wouldn't dismiss hypochondria or mild hysteria that quickly. If you keep hearing people talk about skin infections, you'll notice yourself itching more...
We have far more oncologists now than we did 100 years ago, and far more cancer diagnoses.
If the correlation between increased attention on mental health and increased mental health diagnoses is sufficient to show causality, why not with oncologists?
People didn't start dying once they started getting diagnosed with a cancer, they were dying just the same undiagnosed. That sort of logic doesn't work as well on something as fuzzy as mental health or "are you happy?".
The current movement focuses almost exclusively on the individual. When the best solution to most problems is collective as part of a society, community, family, team etc. It offloads structural problems on the individual and makes people feel bad when they inevitably can't fix themselves. All whilst making money out of solutions. It is similar to blaming climate change on individuals whilst ignoring massive oil companies.
I don't believe that anyone would sign off on this if they'd actually read it. I doubt this bill was about mental health and America's court system's love of pseudo science quackery; this includes stuff like bite marks, lie detector tests, multiple personalities, "recovery" of repressed memories from decades before, etc. This bill was to show that these lege members pass things they haven't read, often I can't really blamed them because the bills are thousands and thousands of pages long and often contain multiple completely different amendments having nothing to do with the bill.
As a web developer, I’d like to think that we’re effectively alchemists who transmute vague ideas into products held together with absurd magic that’s constantly changing.
Can we get a bill going? I can’t decide between “Webmancer” and “www.izard.com”
Psychiatrists are called doctors. Psychiatry is something that a medical doctor specalizes into.
Therapist is a meaningless word, because it's not a protected title. Anyone can call themselves a therapist without third party certification of any kind.
Was surprised this was from 1995, I thought it was current.
Note: Psychology is a real science. It replicates as well as a lot of other 'sciences', studying the mind is not worthless just because it is complicated.
I think studies of the mind will always produce less actionable results because at least part of every person's brain develops uniquely. There are structures which have specific purposes and the neurochemical mechanisms for how the brain develops are shared, and these areas are definitely worthy of study. But a lot of the brain's structure is formed by individual experience of the environment, which is impossible to generalize. Other organs are shaped by the environment but less so because they are simpler.
I wish psychologists and neuroscientists all the best and really hope the fields progress, but we'll never achieve a level of understanding of individual brains and how they respond comparable to say, how heart health can vary with diet. I think it's just the nature of the beast that psychology in particular will remain more art than science.
I used to say similar things. But have found that so many things that were considered 'more art than science', after a few decades go by, are solved. Either there was an underlying structure discovered, or different view point, or additional data. Then it become 'oh, that's known, here is the formula'. They become common, are in textbooks.
Every science has gone through something like this.
Neuroscientist have now been able to scan a brain and re-produce the image the person was thinking of. In 2000 that would be called magic, what about in 2040, will they be able to scan and find out what you are feeling, and then apply some magnetic fields and change your mood. It's now in reach, real studies, real science, the mind is being untangled.
As a legal practitioner, and as someone who has friends within the medical community, I find your outrage odd.
There's a reason why civil courts and judges are often given leeway to decide against the reception of expert testimony - because not all experts really are so. Especially in something like psychology - which isn't really science per se - you'd expect the courts to be more guarded against possible quacks.
Just because you owe your life to psychologist help, doesn't mean that psychologists are all acceptable.
You also didn't read between the fine lines - a satirical document had passed the senate as possible law by "unanimous approval". Which means that the lawmakers who voted in favour didn't really read or consider what was being passed. That's even more embarassing.
Psychologists are made to dress up as wizards to mock and humiliate them, yet priests and preachers who actually believe they have magical powers are taken seriously. Mad world. At least wizards are fun.
I do know it's ridiculous and hypocritical to mock psychology as "wizardry" in a culture where ersatz wizards and the people who believe in them still wield far too much influence.
In their defense, priests at least used to dress up weird by their own choice, making them easily identifiable as non-credible sources. We really should encourage all religious leaders to go back to that convention.
Wouldn't this be to show that they aren't reading the bills they're passing unless someone raises a stink and they have their interns actually read it an report back?
It was an ammendment tacked onto a Bill that had wide support.
The majority who voted likely never read it, those that did rightly figured that it would not pass all the way through and complete, like so many other ammendments on Bills.
Even had it actually passed through it still would not be "solid real law" until it survived being called out for being bullshit and challenged in court.
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[ 2.7 ms ] story [ 181 ms ] threadDoes therapy help some people. It sure does.
Recall, the "reproducibility crisis" came to everyone's attention because of how bad the papers from these two camps were. Nothing really changed, no one got fired, and the situation, seems to have not only not improved but the quality has gone DOWN.
Maybe the law should be they have to wear the hats till they un fuck the last 30 years of publishing...
Edit: to illustrate. Your phone rings. You hear the words. You know which words, the unthinkable ones.
The phone rings, your family just got crushed by a runaway truck.
The phone rings, the company you founded and spend every waking hour of the last four years has a hostile take-over. They are firing you and you find out that the structure of the shares is in such a way that you walk away with peanuts.
The phone rings, your mother is in de hospital, she will probably die before next dawn. You are six thousand miles away.
You know, the gnarly stuff of life.
I mean, you are probably a very stable genius at the moment, but not everybody is and you might not be that for ever. Things can change. If your endocrine system gets a hit somewhere and you get hit by this kind of news. You probably will go into a bad place. I know someone who was severely dehydrated from a viral infection, got into a delirium, then had to recover for 6 years, and still is not the same now.
Bad things happen to almost everyone some of the time. Do you see nearly all of the people on the planet broken down, pshychotic? If you do, I think the problem is with the observer.
Most people are sane despite dealing with bad stuff, which proves the assertion wrong.
As "verified" not by hard measurements (like in Physics), proofs (as in math), or specific clinical results (e.g. blood panels in medicine) but with questionaires and "assessments" by the very people whose continued existance and esteem of the field their careers are based on?
"All kinds of evidence that it works" was there for Freudian psychanalysis too.
Not really, which is why it is all but gone from university psychology research.
The psychanalysis institutes at the time had all kinds of papers and results of their huge success...
Psychology has its successes, empirically proven by getting results in clinical settings, we don't have deep answers on why some of it works or not but working known pharmaceutical compounds also suffer from that, we know they work but we don't know how (some NSAIDs come to mind, psychiatric meds, anesthesia as well).
> ... in 1952 in which H. J. Eyesenck, an English psychiatrist, divided thousands of World War II veterans hospitalized for mental illness into three groups. One group was treated by psychoanalysis, another was given other kinds of therapy, and the third received no treatment at all. The men were then measured on an "improvement scale" with these stunning results: 44 per cent improved with psychoanalysis, 64 per cent improved with other therapies, and 72 per cent got better with no treatment at all.
> More recently, Werner Mendel, professor of psychiatry at the University of Southern California, directed a similar study. Trained psychoanalysts treated the patients in the first group, less highly trained psychologists and psychotherapists treated the second group, and the third group was under the care of employees with no formal training. The improvement ratings showed the following remarkable results: the third group, treated by staff members without formal training in therapy, showed the most improvement, whereas the first group, treated by staff members with the most extensive training in psychotherapy, showed the least improvement. Understandably, Dr. Mendel was startled by the results and repeated the experiment, with the same outcome.
Now, I'm not going down this rabbit-hole (I did once and wasted a lot of time!) but there is a lot of evidence that just a bit of attention from another person may be helpful, and affective attention may work wonders.
[0] https://www.religion-online.org/article/sin-guilt-and-mental...
I hadn't heard of this study. I had heard that the case count for psychoanalytic psychotherapy was insufficient to fairly cluster by symptoms as (e.g. hierarchical) features, even. And then Milgram's selection bias.
Is all "Talk Therapy" bad then, and what's a good way to actually help;
Clean language > Clean language in detail: https://en.wikipedia.org/wiki/Clean_language#Clean_language_... :
> Clean language offers a template for questions that are as free as possible of the facilitator's suggestions, presuppositions, mind-reading, second guessing, references and metaphors. Clean questions incorporate all or some of the client's specific phrasing and might also include other auditory components of the client's communication such as speed, pitch, tonality. Besides the words of the client, oral sounds (sighs, oo's and ah's) and other nonverbals (e.g. a fist being raised or a line-of-sight) can be replicated or referenced in a question when the facilitator considers they might be of symbolic significance to the client.
> [...] "What would you like to have happen?
Clean Language Questions : https://cleanlearning.co.uk/blog/discuss/clean-language-ques... :
> The questions containing the verb ‘to be’ help to keep time still and are mostly used for developing individual perceptions:
> Questions containing the verb ‘to happen’ generally encourage the client to move time forwards or backwards:
> Questions which utilise other verbs are:
A prompt: Leadership and Public Speaking: which can utilize Clean Language; and which are necessarily suggestive of direction, course, or sequalae of events?
Anecdotally, this matches my second-plus-hand observations. In particular, professional "caring" is seen as clinical curiosity (at best) and less authentic, whereas ordinary-person empathy is more meaningful even in small doses.
Relatedly, addicts who seek traditional addiction therapy (anecdotally and second-plus-hand observationally) become lifetime (so far) addicts in how they perceive themselves, even if they quit the substance/behaviour. This tends to have a depressive effect. Addicts who make other changes in their lives which break the addictions have a more reflective view of the different times of their lives (non-addicted, addicted, then non-addicted again), and appear happier.
Addiction and depression are complicated things which I do not have any special knowledge of personally! However, I have varying adjacencies to many people with more complicated lives than my own. I share these anecdotes only because the observations are stark and seem important.
Its weird that we are arguing this. The shift is well covered over the last half a decade. Also whats the point of lots of psychoanalytic papers being published? There exists a ton of string theory papers. Theology is a huge field, once the biggest academic discipline. Bullshit exist, so what.
You could argue it's a coincidence, but it'd seem a highly unlikely one given the therapy was specifically to address that OCD, and the techniques they're using to reduce the frequency were taught by the therapist. And of course it is one anecdote.
I have no doubt there are lots of people for whom therapy is insufficient or doesn't work, but there are also people for whom you can measure the effects in a lot of other ways than the judgment of therapists themselves.
It's that it's scientific and systematic (and not e.g. arbitrary and subjective, whose efficacy is based on methodology but on the specific patient, the specific therapist, their rapport, and such things).
Talking to a friend also helped many a person overcome psychological problems. As did getting a new job, working out, getting laid, and lots of other things. None of those things claim to be scientific fields though.
Care to enlighten us on a better way? We have people who need help right now, not when (or even if) we find some sort of objective test.
Just because we can’t measure something objectively doesn’t mean it’s not important or useful (McNamara fallacy).
I am a “hard” scientist (physical chemist), and like most (old-ish) scientists I have come to appreciate the “softer” side of life.
Doesn't mean they are getting help. Just means we set up a whole cargo cult field from thin air and on thin premises, and make-pretend we help them.
Meanwhile, more important structural changes to get them help, are of course ignored, because they are bad for bussiness or inconvenient (like better work-life-balance, less stressful educational/work/healthcare/late life prospects, more cohesive communities, better access to nature, less advertising and rage bait, and anything that doesn't help with the corporate mills grinding on).
So the specific theoretical frameworks aren't really scientific, at least for the most part. But you can do research on stuff such as whether outcomes are on the average better than without therapy, or whether modality or individual therapists matter more.
Of course the evidence is largely still from the questionnaires, with all of their problems, but the questionnaires aren't necessarily administered by the people giving the therapy so it may not be as biased as you might think.
For a whole lot of psychological conditions that do not get to the extremes the only reasonable assessment we can do is whether the patient feels there is a problem, or exhibit indicators of distress in relation to the problem.
Are you washing your hands so much it is OCD and a problem, or is it just a preference? At the margins - if you e.g. do it so much your hurt yourself - it becomes possible to argue it is objective, but for most people the answer purely comes down to whether or not it is subjectively a problem to them.
That does not mean we can not systematically measure whether people report an improvement under varying conditions and using varying methods.
It doesn't really matter if it is subjective - when the problem is that the patient feels there is a problem, then if the patient no longer reports feeling a problem, then unless you're prepared to assume that they are all in denial or lying, that is evidence of improvement even if it does not raise to the standard of evidence we would prefer.
It would be unreasonable to overstate what that means, but equally unreasonable to pretend it provides no signal in the absence of higher standard evidence unless you can identify specific problems (lack of ability to reproduce would be one).
Or maybe it's just a classic example of a pseudo-field?
>There actually is a mountain of quantitative outcome research across therapy approaches
"Quantitative outcomes" for non-quantifiable conditions means "numerical statistics on answers in questionaires" and such.
>It's readily readable in metastudy form on Google Scholar and elsewhere.
Ah, metastudies, that pinnacle of rigour. "We hastily surveyed 200 varying quality, full of methodological errors, non replicating for the most part, primary studies, and the field is totally a success".
Note how tye very same accusation as yours could be (and was made) for Freudian psychanalysis, homeopathy, and any other bs field.
Uh, I have bad news for you about the reproducibility crisis that's also in medicine/biology.
It's just like psychology but 100x worse because there's real money at stake.
Like the parent mentioned, the reproducibility crisis didn't change anything, we also can't be sure how many doctors actually took these findings into account.
The point I'm trying to make is that it is really difficult to identify bad therapists. It'll take a while before it's reliable enough and that's okay, but therapy gets thrown around as an option like it is.
Does it really sound like the most likely explanation to you? Because I can think about several others.
I mean, it's certainly true that lots of gigantic, complicated bills don't get read properly by politicians before voting on them. But this is about a paragraph and written in clear English, so you'd imagine it would have a good chance of getting read.
prior.... so they knew it was satire.
Maybe 100 years ago this would work, but the modern state is really complex, and the problems are really complex, because if they were easy they would be solved.
The amount of money that state and federal legislatures control is huge, My hunch is that if they spent more on extra staff, the increase in quality of legislation would provide enough economic benefits to cover the cost.
Specifically, this staff:
https://www.reliks.com/lord-of-rings-hobbit/staff-of-gandalf...
See https://en.m.wikipedia.org/wiki/Congressional_Research_Servi... and https://crsreports.congress.gov/search/#/?termsToSearch=&ord...
CRS reports are a phenomenal source of information.
Until then, hereby I vote for them to wear wizard hats in public!
That really sounds like you're implying that modern day astrology is better.
It's shocking how popular astrology still is.
That seems to be a movie plot? "Congratulations on your swearing-in, congressman. Now we'll put on the guillotine collar around your neck."
1) who or what controls the guillotine collars?
2) if you say something in an interview and your head doesnt leave your body. It must be true, right? RIGHT?!
3) at some point a few adversaries that are questioning the guillotine suddenly tell a lie or pass a bad law and get "Sepped" (the slang for head and body SEParation, i.e. your head gets chopped.).
4) going against the party is "objectively" a lie and all people who dont fall in line of "truth" get "Sepped"
5) a law gets passed where everybody wears a mandatory guillotine collar. "We are a Republic of truth! Do you have things to hide? Are you a liar? Then you must fear this law. Only the morally corrupt will fear this law! All true citizens of the Republic will welcome this law."
I think at some point we'll have to acknowledge that pscyhology is a fuzzy field and it doesn't always have the correct answers and somehow balance that with but sometimes the experts are right.
Our society (well, the US and increasingly Europe where I’m from) has put a lot of resources and effort into mental health, largely by following “expert” recommendations.
Tons of people are being treated for mental health, children are medicalised, employers offer mental health courses and insurance, people sharing experiences about burnout, language being changed to avoid offending people, …
Yet the problems keep getting worse.
Maybe the experts are the problem?
Or more likely, the current approach just doesn’t work very well.
If everyone with a disease starts taking a medicine, and nobody gets better, it doesn’t mean the medicine causes the disease, despite the correlation. It just means the medicine doesn’t work.
With other treatments for diseases we always expect the incidence rate to decline — because the treatment works. If it stayed static or went up slightly, then the treatment doesn’t work (and you’re might have slightly higher rates due to new interest in the diagnosis). But huge increases…that’d not be good.
But it's not hard to come up with actual causal reasons why experts are actively making things worse:
1. if people have confidence in experts, they'll seek treatment from them, and forego other, potentially more effective, treatments (in this particular case: making and talking to friends, not therapists; prioritizing family, not shunning them; prioritizing community, not isolating; etc.)
2. experts make a living selling advice to patients, so it's in their implicit interest to keep having patients (either individually, not curing them, or society-wise, making more patients) (there's a lot of anecdata about "I asked a therapist how many patients they actually cured, and they looked at me bewildered")
3. I've seen some opinions, which echo mine, that experts seeking, reaffirming, and reminding patients of their "traumatic experiences" might hurt more than it helps (e.g. talking to therapist every week makes you re-live your traumatic experience; narrowing the definition of "consent" and convincing women they've been raped; convincing children they're trans (they used to be called "tomboys!"); in general marking fairly normal life experiences - job loss, job stress, death in family, etc. - as "traumatic" and "requiring therapy")
probably more
But, that gets the order reversed. People seek mental health treatment after they already have a problem, not before.
It's much more likely that widespread effects are the cause: pollution, social media, poverty, capitalism, racism, etc.
> Maybe the experts are the problem?
I'm not sure I follow your logic. What do you hypothesise to be the causal factor linking these things?
I think we could look to any number of things that could exacerbate mental health issues. Climate disasters, social alienation, rapid inflation, political disillusionment, patriarchy etc.
Hypothetically? It's common for an industry to want to expand their market.
Imagine you're a big drug company, and you make decent profits selling drugs to treat shell-shocked soldiers returning from the front lines after losing limbs and seeing their buddies die right in front of them.
You look for ways to increase your sales and add to your profits. What if you could also sell your drugs to people who've been in bad car accidents? And to rape survivors? And to refugees fleeing from war? And to mothers who had particularly difficult births? And teens subject to severe bullying? What about cancer survivors, or people who've struggled following the death of a grandparent?
It's easy to see how higher diagnosis rates could go hand in hand with higher sales and higher profits.
I can see some logic in you're hypothetical but there are numerous other causal factors which seem much more likely.
Maybe, but I wouldn't dismiss hypochondria or mild hysteria that quickly. If you keep hearing people talk about skin infections, you'll notice yourself itching more...
PS Apart from psychiatrists and priests. Probs they should all wear magic hats when pulling out their expert opinion in court.
If the correlation between increased attention on mental health and increased mental health diagnoses is sufficient to show causality, why not with oncologists?
And employers will pay for some cheap benefits to minimize chances of employees being able to win a lawsuit against them.
However, I move that the hat should have "Wizzard" written on it.
Can we get a bill going? I can’t decide between “Webmancer” and “www.izard.com”
- Terry Pratchett
Therapist is a meaningless word, because it's not a protected title. Anyone can call themselves a therapist without third party certification of any kind.
Was surprised this was from 1995, I thought it was current.
Note: Psychology is a real science. It replicates as well as a lot of other 'sciences', studying the mind is not worthless just because it is complicated.
I wish psychologists and neuroscientists all the best and really hope the fields progress, but we'll never achieve a level of understanding of individual brains and how they respond comparable to say, how heart health can vary with diet. I think it's just the nature of the beast that psychology in particular will remain more art than science.
Every science has gone through something like this.
Neuroscientist have now been able to scan a brain and re-produce the image the person was thinking of. In 2000 that would be called magic, what about in 2040, will they be able to scan and find out what you are feeling, and then apply some magnetic fields and change your mood. It's now in reach, real studies, real science, the mind is being untangled.
Seriously, as someone who owes his life to psychologist help, my blood is boiling while reading this.
It was a satirical proposal from 95 that, while it got surprising approval, was never signed into law.
There's a reason why civil courts and judges are often given leeway to decide against the reception of expert testimony - because not all experts really are so. Especially in something like psychology - which isn't really science per se - you'd expect the courts to be more guarded against possible quacks.
Just because you owe your life to psychologist help, doesn't mean that psychologists are all acceptable.
You also didn't read between the fine lines - a satirical document had passed the senate as possible law by "unanimous approval". Which means that the lawmakers who voted in favour didn't really read or consider what was being passed. That's even more embarassing.
I do know it's ridiculous and hypocritical to mock psychology as "wizardry" in a culture where ersatz wizards and the people who believe in them still wield far too much influence.
Too bad, I was looking forward to seeing female psychiatrists with an 18 inch white beard and a wizard hat on the stand.
But seriously, that this proposal got unanimous support in the state senate is deeply disturbing.
It was an ammendment tacked onto a Bill that had wide support.
The majority who voted likely never read it, those that did rightly figured that it would not pass all the way through and complete, like so many other ammendments on Bills.
Even had it actually passed through it still would not be "solid real law" until it survived being called out for being bullshit and challenged in court.