Therapy Can’t Shake Quackery


I try to write responsibly and limit the use of contempt, but I’ve decided to go with what feels right – much like our president would do – and do so anyhow (i).  I’m sure some will say the title is not news while others will be appalled that this perception exists.


This is an intro into the malpractice that an industry consistently engages in because they have us fooled that they actually know what they are talking about cloaked in their confident responses and professionalism. Psychotherapy, not the science that they ignore but the practice, in many ways is still quackery (ii).

I attribute this to therapists being largely unaccountable entities, having a profit motive, and a failure to define problems and use metrics to evaluate outcomes (iii).  Therapists also show a lack of rigor in their problem solving skills, inability to view problems at the system level, and although they share themes, their guesses on the causes of problems are all over the map.


Notes

i) Contempt allows us to express our indignation on an issue in a big way but at the risk of a processing error.  When the recipient’s defenses get engaged, then they will not be fairly evaluating the content as it falls to the wayside of our need to be right.

ii) The following conclusions could certainly be an overgeneralization as the sample size of twelve that I have assessed may not be representative of all therapists.

iii) Although the industry boasts an effect size of 0.8, which means that most of the time patients that were treated compared to untreated were better off, the meta-analyses used are handpicked and other meta-analyses paint the opposite picture.

Comments

  1. Allison says

    You seem to have already decided on what you’re going to conclude, so I’m not sure what use anybody’s experiences will be.

    My own experiences have been positive, but that’s in part because I’ve been able to jettison the people who were no help (or those who ceased being helpful) and in part because my expectations were IMHO reasonable. The old light-bulb joke about psychiatrists is unfortunately true — the light-bulb has to want to change. The patient is the one who has to do the hard and painful work of changing (it’s open-soul surgery you do on yourself, without anaesthetic), the therapist is at best a coach and a cheerleader. If the patient is looking for someone to “fix” them, they are going to be disappointed no matter who the therapist is or what techniques the therapist uses.

    That said, as in any profession, the majority of therapists aren’t all that competent, and the Dunning-Kruger effect is pretty widespread. There’s also the fact that the personality of the therapist must be a good match for the personality of the patient, because the success of therapy depends on the quality of the relationship between the therapist and the patient.

    • musing says

      I did make a conclusion but was careful to say in “notes” that this could be an overgeneralization because of my small sample size. I probably need to be more clear in what I’m getting at because I am interested in specific concerns that we have and how do we know that they were resolved or not.

      And changing the perception that a person can be “fixed” is important in the sense that it underscores the reality that change is a process but is often used as an excuse to not problem solve. You do point out one important strategy of therapists in that they aim to be “coaches” and not “enablers”.

      So some don’t give advice, but give you tools instead for you to apply. I don’t have a problem with that, and they are increasing our self-efficacy, which is a measurable construct concerning our beliefs in our abilities to accomplish things. But, again, if we don’t attempt to define the issues, then how do we measure success?

      We can always define problems in a way that our expectations are reasonable and dependent on a host of assumptions. But we must at least try to define it in the first place. I have had therapists say that the only thing that matters is how you feel when you leave therapy, meaning that was their yardstick for success.

      But how do we know if the concerns we had, however defined, won’t reappear later, and we feel good because the therapist provided a boost in social acceptance. Social acceptance has a huge unconscious affect on mood and would be a confounding variable that interferes with measuring the success of therapy.

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