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Psychotherapy

Jeff Wagg

Illuminator
Jeff Wagg
Joined
Sep 24, 2003
Messages
3,125
Location
Chicago
I have been a pyschotherapy client and am now enrolled in a Masters program in Mental Health Counseling.

I endeauvor to think critically about things, but I have to admit that this field makes that very difficult. It's filled with untestable theories, models, and as I'm learning, insidious political ideologies.

So my question to other folks interested in critical thinking and with an opinion - What are your opinions on the general theory of the "talking cure," and how does one think critically about ambiguous and untestable theories?

Any psychotherapists out there who'd like to chime in? I have no agenda; I'm just seeking a general discussion.
 
It depends on what you mean by psychotherapy. There are a vast range of types, and within each type a wide range of theories. I have no idea what the situation is in the US, but until a few years ago there was no regulation in the UK, so anyone could set up in practice calling themselves a psychotherapist.

I should point out at this juncture that I'm not an expert, or even a psychotherapist, but I am a very well informed layman.

I guess the real question you're asking is, does psychotherapy actually work?

Most people who undergo therapy don't actually require it in a medical sense, but that doesn't mean that they don't benefit from it. Let's face it, most people would benefit from talking about their problems to someone unbiased and non-judgemental.

I don't have any figures to hand about the benefit of psychotherapy for more disturbed people (although I'm sure that studies have been done), but I certainly have lots of anecdotal evidence that it works.

The clinically insane should, of course, be under the care of a fully qualified psychiatrist, and any psychotherapist who tries to deal with them should be beaten severely about the head.


ps I know that this response is a bit rambling and not entirely coherent, but that's kind of how I'm feeling today!
 
wollery said:
ps I know that this response is a bit rambling and not entirely coherent, but that's kind of how I'm feeling today!
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Would you like to talk about it? :p
 
Jaggy Bunnet said:
Would you like to talk about it? :p
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:D

Thanks, but I know exactly what the problem is, and besides, I already know dozens of psychotherapists, psychoanalysts, psychiatrists etc.

In fact, I probably know more shrinks than most shrinks do! :(
 
Jeff Wagg said:
Any psychotherapists out there who'd like to chime in? I have no agenda; I'm just seeking a general discussion.
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I'm not a psychotherapist, but I'm currently training in clinical psychology in the UK, and as part of this I'm training in several psychotherapeutic approaches.

As wollery pointed out, there are many different types of psychotherapy (some would say as many as there are psychotherapists), and they all have varying degrees of evidence base.

Some of the most common and best-evidenced techniques include cognitive therapy and cognitive behaviour therapy (CBT) - there really is a ton of research on what these techniques are effective for.

A really good starting place to look at the research behind these and other approaches is Roth & Fonagy's book What Works For Whom?; an excellent critique of poor practice in the psychotherapies is Lilienfeld, Lynn & Lohr's (eds) Science and Pseudoscience in Clinical Psychology; also there are various journals which can give you a picture of the current state of research (e.g. British Journal of Clinical Psychology, Clinical Psychology Review, or various APA ones are good).

I find in psychology that politics doesn't creep in too much, other than as part of either NHS policy or ethics; however, most of my colleagues seem to be fairly left-leaning, simply because I guess it's the kind of profession that attracts left-leaning people.

As far as the therapies themselves go, there are some attitudes built into them which could conflict with various political positions - for instance, the very common notion of 'unconditional positive regard' for a client, and accepting them as a valuable person whatever they might have done or thought (i.e. neither condoning nor condemning their actions, but working with what they've brought to a session). Personally, that sits okay with me, and I consider more a matter of personality than politics, but I can imagine it might be difficult for some.

There are certainly barmy psychotherapies though, which range from useful approaches with poor theoretical validity (e.g. Jungian dream work can be useful as a counselling tool to address difficult topics, but has little evidence to back up its central notions of collective and individual unconscious, sybols & archetypes, etc.) to approaches that don't necessarily not work, but need far more research and theoretical basis than they do now to justify their use (e.g. Eye Movement Desensitisation and Reprocessing therapy), to some that are just plain silly (e.g. Thought Field Therapy, Energy Psychology, etc.).

The untestable theories etc. that crop up do so throughout; how I react to them personally depends on specifically what they are. Do you have any examples? Which approaches are you studying?
 
You might like a look at Robyn M. Dawes' book House Of Cards.

As far as the talking cure works, the main conclusions from research are

(1) It is effective.
(2) Efficacity is unrelated to the professional qualifications of the therapist.
(3) Efficacity is unrelated to the length of experience of the therapist.
(4) Efficacity is unrelated to the theoretical bias of the therapist.
 
wollery said:

I guess the real question you're asking is, does psychotherapy actually work?
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Well, I know it works. I woudln't have endeavored to enter the field otherwise. But I am encountering some unexpected things which I will related in the next few posts.

What I am looking for is a basis by which to judge different theorectal approaches. "This one works, this one doesn't" isn't going to cut it.

By the way, you're dead on...it's not the sole treatment for any form of pathology. I'm more interested in working within the "normal" range of mental behavior.
 
Jeff Wagg said:
What I am looking for is a basis by which to judge different theorectal approaches. "This one works, this one doesn't" isn't going to cut it.
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Why not?

Surely failure in practice is the best refutation of a theory.
 
Re: Re: Psychotherapy

Nucular said:

I find in psychology that politics doesn't creep in too much, other than as part of either NHS policy or ethics; however, most of my colleagues seem to be fairly left-leaning, simply because I guess it's the kind of profession that attracts left-leaning people.
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I've always considered myself somewhat left of center, but I have had a huge awakening and that area. The culture at the school (University of Vermont) makes me rather uneasy at times. As a middle-aged white male (which I'm reminded of CONSTANTLY), I'm coming from a different place than most of the students who are 20-something women.

Nucular said:
The untestable theories etc. that crop up do so throughout; how I react to them personally depends on specifically what they are. Do you have any examples? Which approaches are you studying?
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Let's see, the ones we've spent the most time on:

Freud - I like psychoanalysis in practice, but the theroy part is, in the words of a shink I know, "psychotic."

Adler - Seems like a more reasoned approach to Freud.

Gestalt - Some interesting techniques, but not enough as a package.

Reality Therapy - I like this one. I'll be taking quite a bit from it.

Behavioral Therapy - Nice and testable, but only applicable to overt behaviors. How would you use this with a grief-stricken patient?

CBT - I understand its effectiveness in the short term, but I'm concerned about things like "thought stopping." Where do those thoughts go when you stop them? Do they just dissapear? Freud would say not. I'm not sure.

Narrative Therapy - I don't mind the technique, but the postmodernist anti-reality stuff really bothers me. There's a thread in the philosophy forum about this.

Family Systems is coming next semester.

I know I'll end up being ecclectic, but what criteria am I using to pick and choose?
 
Dr Adequate said:
Surely failure in practice is the best refutation of a theory.
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Each therapy is an individual event. There is nothing standard, as the therapist must tailor the therapy to each client (my opinion).

How do you know what to attribute a failure to?

Also, EMDR has a good success rate, and it's bogus.

I'll check out House of Cards. Your quick summary matches my current thinking. I already have the other books mentioned, although I haven't read them yet.
 
Oh, one quick thing. In the State of Vermont, anyone can sign a piece of paper and call themselves a "psychotherapist." The program I'm in culminates in licensure as a Licensend Clinical Mental Health Counselor. That includes diagnosis, treatment, third-party billing, etc.

I prefer the term psychotherapist though, because the term "counseling" has been so diluted by such things as "fragrance counselors" in department stores and "fitness counselors" at health clubs.
 
I can't give you any references to any actual science in the field, because I don't think much, if any exists. But I'll give two anecdotes:

1) My ex-wife and I did a program to teach English to people, mostly schizophrenics, in a state mental hospital. There are a lot of people from other countries who get committed but who can't speak English. We didn't do any psychotherapy at all. However, the results were astonishing. People in the class were discharged at a rate twice that of the hospital at large. Everyone in the class had a demonstrable improvement after one or two lessons in their basic coherence, which was independently verified by the nurses at the wards and the other residents.

2) Words from a psychotherapist, who said, "I talk to them for a while, and eventually they get better at talking to themselves. I don't know what it is that I do."
 
epepke said:
1) My ex-wife and I did a program to teach English to people, mostly schizophrenics, in a state mental hospital. There are a lot of people from other countries who get committed but who can't speak English. We didn't do any psychotherapy at all. However, the results were astonishing. People in the class were discharged at a rate twice that of the hospital at large. Everyone in the class had a demonstrable improvement after one or two lessons in their basic coherence, which was independently verified by the nurses at the wards and the other residents.
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Amazing, maybe the whole psycotherapy is wrong from the beginning. At least the psychoterapists that charge like if they actually could "heal" should then disappear! :D I have always disliked all the freudian nonsense, btw.
 
Yes, as various people on this thread have pointed out in different ways, some of the most important aspects of therapy are common to most therapies - process and engagement issues, space to talk, a supportive relationship, a feeling of 'something is being done for me', etc.

This is what led in the 70s to the "dodo bird" study finding - that all forms of psychotherapy were equally effective. As the dodo bird said in Alice In Wonderland, "everyone won - everyone must have a prize". Which annoyed most partisan psychotherapists.

This finding has been replicated really quite a lot since then, and, as a generality, seems to stand up; however, as Roth & Fonagy in the book I mentioned earlier imply, this does not mean that psychotherapy is made up of a lot of different coloured 'one size fits all' jumpers - different approaches are clearly more or less suited to different problems, or, more importantly, different conceptions or formulations of a problem. That's why being eclectic is a pretty good idea, from where I'm sitting. Tools in the toolbox, and all that.

As to criteria to choose by - lots of people would say that your first current criterion of "I quite like that, I don't like that" is as valid as any: that the important thing is that it suits the practitioner. Personally though I think your second criterion is much more important - that its theoretical concepts are valid, and that it 'works'.
 
Re: Re: Re: Psychotherapy

Jeff Wagg said:
Freud - I like psychoanalysis in practice, but the theroy part is, in the words of a shink I know, "psychotic."
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Yeah - Freudian psychoanalysis in practice has its merits - one being that its extremely prescriptive nature (the therapist has all the answers, and simply explains them to the patient) feels a bit safer and more concrete to the clinician. However, in terms of regaining reponsibility both for whatever has come before, and for 'getting better', (an integral part of reality therapy, which you also like), this prescriptive approach may be less helpful.

To me though, the major problem with Freudian psychology, whether as a developmental model (the life stages, etc.), a cognitive model ('the mind is like this'), or a therapeutic approach, is that there is no reason to think that the mind or the self are actually at all like Freud claims. Webster does quite a good job not only of showing it all up as pseudoscience, but also of showing where the odd notions came from, in his Why Freud Was Wrong.
Behavioral Therapy - Nice and testable, but only applicable to overt behaviors. How would you use this with a grief-stricken patient?
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Yes, to deal with feelings of grief, this might not be the most helpful approach; some of the principles can still be applied to the grief situation (e.g. an activity hierarchy to deal with specific resulting anxieties), but they are better used in such cases in conjunction with cognitive techniques as per CBT.
CBT - I understand its effectiveness in the short term, but I'm concerned about things like "thought stopping." Where do those thoughts go when you stop them? Do they just disappear? Freud would say not. I'm not sure.
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Well, Freud would base that idea on his unevidenced model of mind, including repression and related ideas. CBT should include future strategies for relapse or recurrences anyway, but the CBT conception of cognition simply sees problematic thoughts decreasing, not 'going' anywhere. Seems rather more accurate to me, and I think it's also more congruent with academic cognitive psychology.
Narrative Therapy - I don't mind the technique, but the postmodernist anti-reality stuff really bothers me. There's a thread in the philosophy forum about this.
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I haven't read the philosophy forum thread about this, but I also have felt a bit uncomfortable with these notions. Part of being a trainee is that you have to become 'temporarily' comfortable with things because they make you do them anyway; only qualified people have the luxury of putting opinions into practice.

But I do think, now, that it's not actually making a statement about reality, but socially agreed meanings of problems. The same thing crops up, you'll probably find, with family/systemic therapy and solution-focused therapy. It's more of a kind of polar opposite to Freudian authoritarianism - in this case, the therapist has none of the answers, but simply hypothesises and tests out guesses with the patient(s), who does/do have the answers. Some problems, I think, can be quite well described as a product of people's understanding of and reactions to a situation and each other, rather than by the situation itself.

What does annoy me, though, about these postmodern approaches, is that most practitioners seem to think it gets them off the hook as regards evidence-based practice. Why this should be is beyond me.
 
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