My spouse is a psychotherapist, and from her 10+ years of work I have seen that it can work very well. But the success depends on the patient’s mental attitude. If you go to a therapist with the mindset „here I am, do something that I feel better (again)“, then I can guarantee you you‘ll be disappointed. A psychotherapist is like a midwife who can help a woman in giving birth to a child, but the woman must go through the process herself, through the pain, the labour. But when you come with the right mindset, do the work, do not expect quick fixes, the results can be transformative.
Once you figure out what your issues are, you might however find yourself going to therapists with the questions “what are we to do or what am I to do about it?” And finding they have no answer. Just, “yea it’s a process…”
There‘s a therapy form that can help you in that case as well: Behaviour therapy. But if you try to understand the root causes (in the present) of your problem(s), you need psychodynamic psychotherapy. Both will be helpful. Depending on your needs.
Exactly this. There are multiple types of psychotherapy, each with a particular focus oriented toward particular themes and goals.
It’s easy for the layman to misunderstand how these different types work in practice and for what circumstances they’re well suited.
I once underwent psychodynamic psychotherapy for a serious interpersonal relationship problem that was taking a devastating toll on my life. When I had reached a point where I was ready to discuss what (if any) therapy came next, I thought CBT (cognitive behavioral therapy) would be right for me after reviewing the particulars.
It’s important to note that along with different therapies, psychologists are also quite different. There are different schools and concepts that a psychologist may subscribe to or favor, and of course each has their own personal approach and style.
It turned out that on paper I thought CBT would be a good next step, but when I got there with a therapist who specialized in it, it wasn’t what I needed or wanted, and while I liked the therapist, I didn’t much care for their style of rapport building.
I’d like to read on actual techniques, cause this post makes me suspicious. That question “how do I feel about it” is only a first step in a complex approach and the focus on it may suggest that there’s something missing in my picture. Which is lots of circumstantial techniques and ideas. I wouldn’t think of pointing this particular question out from all that if I was writing a blog post. Maybe I’m just different?
Anyway, I agree when they say that people who need therapy the most are the ones who cannot afford it. It makes you think different, not just pat you on the head and commiserate.
> That question “how do I feel about it” is only a first step in a complex approach
On the other hand this is where therapy starts and ends. Ultimately a therapy is started because the answer to it is too negative. And if it's positive enough afterwards, it means the therapy was successful.
Or to put it the other way, there are issues where a Psychological tag can be put upon. After all the classification is largely a statistical one. But no therapy may be needed when the person is doing well.
Obviously things are more complex but from someone seeking Psychotherapy this is what it boils down to. Granted, some problems cannot be solved by Psychotherapy but that's a different topic.
Also I think it's worth mentioning that many people cannot even answer this simple question. No expert on this, but my presumption is also that through expectations e.g. in society and the career objective points are more in focus and not so much how an individual feels about it.
Yes it indeed was the question asked by the Therapist and that made me realize I've not been asking that often to myself. The question made me think and made me feel uncomfortable.
So now whenever I am in a tricky situtation, I ask myself that question. It gives me more understanding of my feeling.
And once I've more grasp on it, I can tackle it better.
Try group therapy! It can significantly change your life. I was saying "no fucking way" whenever my psychiatrist suggested it, but after I tried, it turned my life upside down in the best possible way. It will be very uncomfortable first, but worth it!
A bad day in therapy doesn’t mean the therapy is bad. I’ve had proper arguments with my therapist and even asked to quit multiple times. Thankfully stuck with it and turned out to be part of the process
Really all you can do is stick with it for a few months and see if you get better. It’s hard to tell in an immediate moment if it’s good
The expressing of emotion comes with a lot of side benefits: the other person becomes aware of your feelings (yes, people generally don’t know how you feel about something). They will respect your boundaries better.
You can tell they've never dealt with a person with narcissistic / sociopathic personality disorder. You express your emotions to them, all it does is provide them with a crystal clear signal of how to push your red buttons and believe me they will.
A lot of therapy is based on the assumption that "we're all the same" or "we all mean well" but it's simply not true. There's real scum out there.
Yup, and that's a particularly important lesson in context of group dynamics, where a large enough group (of say 10+ people) almost certainly contains some bad eggs, and if you present yourself as either isolated or psychologically vulnerable, these people WILL single you out.
Though the corollary is true as well - if you meet enough people, sometimes you will get to find folks who surpass your expectaions.
This is particularly shocking if you were raised in a somewhat healthy family and then go out to the world oblivious of how ill-intended average people are (way more marked on big cities).
Many people actively work on making other people's lives miserable, everyday.
The solution to this, by the way, is not to become more sociopathic but just to be aware they exist and how they operate. The kind of schemes they put together are embarrassingly simple to understand and spot, but only once you know about them.
I always thought that coursework/lectures on this topic during high school would be extremely beneficial for the young and perhaps even quite fun to go through.
The concept of "good therapist" can be misleading, as it suggests the idea that there good therapist necessarily work well with any patient (and as a consequence, patients may give up too early in their search for a therapist). I think it's more appropriate to talk about "suitable" therapist.
In a way, it's like talking about friendships. Some people certainly have better "friendship skills" than others, but because a given person has such skills, it doesn't automatically make them a good friend to everybody.
I don't know, about 15 years ago I tried therapy for anxiety/depression.
The 1st one asked me the most basic nonsense and then told me she thinks I just drink too much coffee so I didn't go back.
The second one told me they don't believe in medication so I never went back.
The 3rd one diagnosed me with seasonal affective disorder in about 5 minutes, gave me a little prozac and changed my life.
I suspect there is an overwhelming amount of terrible therapist.
I don't think the challenge is finding a good therapist but in not getting stuck with a terrible therapist or letting a terrible therapist ruin the whole idea of therapy.
Idk which was worse in my experience, the one with basic nonsense or the one who prescribed me SSRIs after a short talk. I quit by myself after a couple of months and will never touch this crap or walk into his office again.
Sorry but to me sounds like you just embraced the first one that gave you drugs. Not that you dind't need it...but 5 minutes for a prozac prescription?! That's absurd.
> I think it's more appropriate to talk about "suitable" therapist.
Can you say any more about how a therapist might be more suitable for some patients than others? Is it about a methodology (like cognitive behavioral therapy), or about disorder(s) the therapist usually treats (like addiction), or is it something else (possibly something the patient won't discover until after treatment starts)?
I agree. I’m a bit horrified when I hear about other people’s therapists being universally affirmative yes men. Then again, other people seem to be horrified that my therapist challenges me
Therapy didn't work for me, and looking back the whole concept seems just bizarre. If you run with the assumption that at least two thirds of therapists are either terrible or just terrible for you, that means that you have to visit at least 3-5 of them, and even if you actively know this, you have to spend 3-4 sessions with them, during which you have to unconfortably open up to a complete stranger, and tell them things you wouldn't be comfortable telling to your own mother.
Imagine if any other doctor operated like that like you had to visit 3-5 endocrinologists to get a diagnosis for your thyroid disorder.
And even if you find the right guy/gal, the best they'll probably be able to do is help you help yourself, as most of the problems in ones life have external causes, and it falls to the individual to resolve them.
It's just baffling that this is considered a legitimate medical discipline in 2025.
Even though self-help is considered a meme, I found way more success with it, as flipping though 5 different books until you find the one that you like and is much easier than visiting
5 therapists. And being honest with yourself is also much easier than being honest with a complete stranger.
most of the problems in ones life have external causes
Most mental issues have internal or behavioral causes. Therapy addresses your ideas about the real world, not the real world itself. For example, it can enable a choice never seen as possible before, and while the real world stays the same, your position in it may change to something unthinkable before.
The problem with mainstream therapy is that, unless you're being treated by a psychiatrist, there's very little in the way of objective evidence of therapy working.
Sure, lots of self-reported successes by patients with no control to compare against, but at this point there is just as much self-reported evidence that prayer works.
For medical treatments, the bar should be higher than "patient believes it worked".
Therapy is skills training, not medical treatments. Which is also why the reliability is varied - not everyone wants to learn mental health skills. Not everyone who learns them wants to do them. Not everyone who wants to do them is able to make themselves do so.
When you go to a psychiatrist, now we are talking medical treatments. That is where you get a specific diagnosis and possibly medicine to change how your body and mind work. That is where to expect objective results.
Both explore what is needed by talking to patients, often with some testing... but they are not the same thing. And neither are going to solve all problems for all people. But it helps to evaluate them properly if you understand what they are, and what they are not.
Some skills training is well supported by empirical evidence. People who take piano lessons observably improve their ability to play piano, on average, even though some don't, even though they often regress after they stop, and even though some people improve without taking lessons. Similar remarks apply to golf lessons, JavaScript bootcamps, calculus courses, and plumbing apprenticeships.
Most kinds of therapy, by contrast, are closer in their empirically measured effectiveness to studying geography through astral travel or studying history through past-life regressions. CBT and exposure therapy are among the few exceptions.
> but at this point there is just as much self-reported evidence that prayer works.
If you remove the assumption that a deity answers the prayer; what they're doing is focusing on gratitude and if asking for things they are identifying goals. This is a healthy mindset so unsurprising that they report it "working".
I believe this view is actually outdated -- it was actually true in the past, but I know that currently "Cognitive Behavioral Therapy" does define things much more objectively than previous approaches...
It's a bit unfortunate that people out of the psychology area don't even really know that there are multiple different Psychotherapies approaches and that they vary wildly in how problems are tackled/studied (source: my wife works in the area).
No. CBT is still a mumbo jumbo of concepts and approaches that have no relation to reality (like any other therapeutic school), other than "if you follow these practices, you will maybe get better".
You'll not be able to prove validity of the concepts behind this school of therapy themselves in any other sense, even if you would be able to identify some coherent set of concepts from all the various techniques and approaches that CBT subsumed over the years.
And certainly just because "if you follow these practices, you will maybe get better" metric does not say anything about validity of the concepts of a particular school of therapy in any case, no matter what school you're talking about.
I mean yeah, many people usually care about whether some therapy works and how well, and not whether the concepts that you're told in therapy to justify what the therapy is doing make coherent sense or can be scientifically validated, so this is usually not a problem for people in need of care. But idea that CBT's concepts are more objective than other mumbo jumbo therapies out there is just plain wrong.
if you follow these practices, you will maybe get better
Idk if my therapist used something from outside of CBT, but he definitely marketed himself as a CBT-ist. I was never given this "these practices" thing. I've solved my:
- Environment control anxiety (long story)
- Strong anxiety of being late. Eradicated via specific methods that I fully understand and were specific to me: recollecting the actual source event through pre-sleep questioning, realization of specific anxiety behavior loops (just by talking about my routines) - long preparation and inability to do anything deep 4-5 hours before an appoinment, then few times intentional being late, then later unintentional, now I mostly don't care when it's not a big deal and not my need. Can just do my things up until a notification, or miss it completely.
- Depression with one heavy clinical episode without using pills. Basically I have found a key misconception in my life, work related, and adjusted thoughts radically to a real reality rather than old made-up (which was so comfortable to people I worked with).
Is that mumbo jumbo? Cause if it is, I couldn't care less how anyone calls it. That said, I can see how different people could fail to perform the methods and ideas involved. It really requires a skill of debugging and questioning yourself. Lots of people are too stubborn to even think about being less stubborn for just a minute, ime.
Yes, it's still mumbo jumbo. And yes, I acknowledged your view in advance in the last paragraph.
Therapy school can have simplistic invalid theories of functioning of human beings, and still be useful to some people. Just like religion can be psychlogically useful to people but it's all nonsense. Whether some therapy works says nothing about rationales and theories behind it, in other words.
Whether you got better or not is irrelevant to the question of whether CBT views on how human beings function are valid.
I’ll try to take your point and let’s assume that it worked for me due to “therapothropic principle”. But I have three questions, all seem to be related.
1) It still involved structured work without which it couldn’t sort out on itself. Okay, this is still religious. I believed (wanted) that it should work, and it did. But we’re talking about modifying thinking itself here, beliefs themselves. That’s a strange area because how can you even avoid that? It’s sort of an incompleteness theorem thing. Like, a therapist changed me, but he can’t change those who don’t believe in change, while “belief” is a part of the… yadda yadda. Iow, how does one falsify a therapy, I guess?
2) Since we’re talking statistics and not structure (are we?), can it be that naturally only a part of population can be “cured”? Like, you can’t cure really bad medical cases either, and some of these are common. What if there’s a consistent set of prerequisites and “therapothropism” is not random? I guess this question is naive and there’s more to it, but can’t think of anything here.
3) In my experience, religion is much more shallow wrt to “you”, and is fixed. In a sense that cbt solutions are more “meta” and then get tailored to the personal events. While religion is usually an omnidude watching you and many others and rules and requirements are all the same. CBT actively refrains from judging and giving specific advices. Even from both-religious position, is it fair to put both on the same line?
Exposure therapy for PTSD, phobias, and other anxiety disorders has lots of evidence from clinical trials. It is based on animal studies of “fear extinction”. You often see good results after 10-12 hours of focused therapy sessions.
How would you even measure the improvement of mental health objectively? You can’t just measure some levels of neurotransmitters and say “okay this is better, dopamine went from X to Y” because the patient may not feel any better.
It’s not like with a broken bone where you can look at an image of the bone and see that it has healed, you have to rely on what a person tells you, which is inherently subjective, and since a person can’t be cloned, you can’t have a “control” either.
Just because you can't think of a way to measure mental health doesn't mean a way doesn't exist. Scientists have ways of measuring subjective things in objective ways, they're not perfect but you can read the papers where they define them and then find other papers where they're useful.
Once it becomes measurable, then you can implant emotions into AI agents. Once you an AI identity that is emotionally indistinguishable from us non-AI identities and which is infinitely smarter than us, what purpose would we have left to fulfil?
My purpose would remain unchanged. What you’re asking is almost the same as asking, “If a person exists who is better (smarter, stronger, more attractive) than you, what point is there in existing?” Because I experience life subjectively and would prefer to continue doing that.
You make a good point - purpose is very subjective and personal. Maintaining that purpose regardless of outside influence becomes the hard bit!
OTOH what happens if there is a whole species of beings who are smarter, stronger, … than our species? Would our collective purpose become to accept them as our betterment? Our personal purpose would vary greatly from fear to wonderment.
Measurement of subjective wellbeing has a long history in healthcare and can be very useful for both treatment and research; see e.g. pain scales: https://en.wikipedia.org/wiki/Pain_scale
If you exclude people with diagnosiable mental illness, it seems like it would be hard to come up with an objective definition of therapy "working" beyond patient self-report. Its not like its a broken leg where you can test how well they walk.
If the patient is happier, does it matter if there isn't an objective measure.
Quite to the contrary, while there is plenty of evidence of specific types of therapy yielding actual results, there's often very little evidence of the methods commonly applied by psychiatrists (i.e. medication) to be actually beneficial.
In fact, some types of psychiatric drugs (with SSRIs probably being the worst offender) are actively harmful, while evidence of their presumed positive effects is vague and ambiguous at best.
if you learn things from therapy that improve your life then i guess it has worked.
i imagine success stories tend to self-select as well. if you go to therapy in the first place it means you're admitting a need and willingness to change.
if a person thinks they know everything and can't benefit from therapy then they're probably unlikely to gain anything from the experience.
> if you learn things from therapy that improve your life then i guess it has worked.
To give a very "Hacker-Newish" snappy remark:
So, if the therapy teaches you programming, and you thus get a much better job improving your life, you'd claim that "learn to program" is a suitable therapy? ;-)
For CBT therapy, the evidence strongly suggests that it does help in the vast majority (but not all cases). More research is still needed to your point, and we can acknowledge the research done so far has provided evidence in favor.
"The effect's associated prediction interval −0.05 to 0.50 suggested CBT will remain effective in conditions for which we do not currently have available evidence. While there remain some gaps in the completeness of the evidence base, we need to recognise the consistent evidence for the general benefit which CBT offers." https://pmc.ncbi.nlm.nih.gov/articles/PMC7856415/
"Eleven studies compared response rates between CBT and other treatments or control conditions. CBT showed higher response rates than the comparison conditions in 7 of these reviews and only one review reported that CBT had lower response rates than comparison treatments. In general, the evidence-base of CBT is very strong. However, additional research is needed to examine the efficacy of CBT for randomized-controlled studies." https://pmc.ncbi.nlm.nih.gov/articles/PMC3584580/
We know how aromatherapy, homeopathy and acupuncture works, it's called the placebo effect. Now maybe you meant to say: we don't know how the placebo effect works.
There are standardized diagnostics and measurements of severity for many, if not most, psychological disorders.
There is an extremely large body of evidence that therapy substantially improves psychological disorders as measured by these diagnostics and measurements.
The comments claiming no evidence are totally baffling, there are mountains of studies with data. This thread scares me with the amount of misinformation being aggressively pedaled.
People report that you may skip over dozen of therapists until you find the one. They just suck, cause it's an area filled with uh-huh listener scam for your $$$.
Not the right one, but the one who actually practices it instead of giving vague mom/dad’s advices.
always
That should mean something. But I agree that people may omit important details about the structure of their therapy work, so it may not feel convincing. To make sense of what I mean by therapy, look at my recent comment history. It does not boil down to the “emotionally right” one. I’m quite different from and not really emotionally connected to mine, for example, although I respect his professional skills very much.
I hope this doesn't come across disrepectful, but its kind of weird the take away from 1 year of therapy is so cliched.
The take away is basically you should pay attention to your emotions, don't be afraid to express your emotions and don't be afraid to try new things. Which feels like something you would see on instagram written over a sunset.
Perhaps its just a case of the difference between knowing the path and walking the path, and the 12 months was learning to walk it.
It is exactly that. I've also been in a pretty intense therapy for 12 months (3 hours a week) and all the takeaways are really obvious. That I had to take responsibility for my life, that I would feel better if I made my life better, to step outside my comfort zone, etc.
Therapy isn't really about the advice but actually transforming it into action, as you say, walking the path instead of just knowing the path.
But for someone who is, let's say, suffering from depression, the aforementioned path sounds like cheesy bullshit and not a source of happiness at all. They don't do those things for many different reasons depending on the person's psychological history, and the advice sounds empty because they don't realise it actually works.
I had been avoiding that advice, pretending outwardly that it was bullshit, for 30 years of my life. Those cliche Instagram slogans actually do mean a lot to me now, it just turns out I literally spent my entire life until now unconsciously, but actively, avoiding them.
The way I learnt to take my first step on that path was to understand the rich psychological tapestry that caused me to avoid the path.
I really enjoyed the post, especially its focus and brevity. I agree with your last thought. In my experience, there's a significant gap between understanding something intellectually and understanding how to live it. Therapy seems to focus on the latter.
friends as sole outlet for deep issues can strain relationships and offer biased advice—they’re a support system, not a substitute for professional, objective therapy
At the species level the nature couldn't care less about a single specimen. If you have offspring, suffer as much as you want. If not, too. Suffer anyway, just leave offspring. Or not, who cares.
Professional therapy (at least the one I experienced) uses well-defined methods in addition to drawing parallels and analogies. Downward arrow, event/emotion logging, exposure, core belief removal methods, etc. I was really intrigued when I realized that therapy is not about whining and listening to "it's okay" or shallow advices, but akin to debugging and programming with a mentor who already seen most bug like yours and only needs you to start dumping logs to confirm.
You can come up with something vaguely like this by accident, after talking to lots of friends. But why bother if you have a professional who can point out the inconsistency and suggest/explain the way to solve it in just in a few sessions?
I'd say people for a long time, in many cultures have gone to trusted faith leaders or elders to seek guidance their peers weren't suited/equipped to give.
Those harder times that caused more trauma were themselves almost always caused by traumatized people who had no way of getting help. Friend/family support systems rely on people actually knowing what to do, and most have no clue whatsoever. The treatment for "shell shock" was to man up, and "hysteria" got you an ice pick to the brain.
Evolution works on the scale of millennia, we've been the same organism for the past 300k years and it's random best effort that only selects based on what kills you before you procreate, it doesn't guarantee anything at all.
Neither one can still substitute for the immersively subjective realities in which our psyches were formed around, nor even begin to answer how that relates to everything we pick up and carry throughout our lives. Perhaps it would take an equally intense experience, developed over a lifetime and coupled with accurate insights into how those relate to the brain, to change some deep-seated traits or begin to answer how something such as a disorder actually behaves in the brain.
1. Older adults are less open. I wouldn't just start texting someone from work about my favorite bands after knowing them for a couple weeks. In college that was common.
2. Children and family responsibilities are primary relationships, while in college friends are primary relationships.
3. Energy levels drop and responsibility rises as you age; limiting what you want to do.
4. There is a light social pressure to "act your age" that has a small governing influence to adult relationships.
I have good friendships, but almost all of my adult friendships are from college and highschool. Hanging out is usually a set activity like hopping on a game, grabbing lunch, or maybe biking, golf, etc on a sunday. Work is where I meet people and all of those relationships tend to be tainted by the professional relationship.
