I think this is on the money. I think it is possible that there are many therapists who justify the existence of their profession by changing dozens of people’s lives for the better. And also that there are the many therapists that cause people to interpret the phrase “go to therapy” as a threat.
I have not met, in person, good therapists, but some of the best advice I have ever received began with the phrase “my therapist said…” so I have to believe they’re out there somewhere.
I'm sure supportive therapy is useful to more and more people these days. But I have to wonder - if it's basically just talking things through with someone, how sad is it that people aren't already getting that from their lives? Insofar as I have an issue with the rise of "therapy culture", that's why. It seems like a pale, shallow, and *expensive* substitute for something that people should be able to access for free through normal human relationships.
I don't believe a therapist would go through so much expensive, time-consuming education and make so little money if they had ulterior motives. They don't get self-esteem and a good reputation and referrals from doing their clients wrong.
Absolutely. Not everyone is good at their profession. When we hire people, we need to choose well. Same as talking to friends, not everyone is a good friend.
Not "ulterior motives" per se. There's a genuine desire to do good. But toxic enough misunderstandings can cause harm regardless. And the education you're alluding to is specifically inculcating some of those misunderstandings. See the last part of this article especially:
This is a large reason why I have not yet tried therapy. I feel like a crazy person for thinking it, but knowing what I do about the politics of the profession, and the way people with relatively ordinary libertarian political beliefs tend to be treated in academia, I have a hard time trusting a therapist not to treat my closely held moral beliefs like some sort of pathology. I know that concern is probably unreasonable, and that I have plenty of actual pathologies I'm sure they would be plenty busy with without judging my politics, but I've just been unjustly called a racist and a nazi too many times to trust someone who is statistically speaking almost certainly strongly affiliated with the Blue Tribe to poke around inside my head.
If you think it could benefit you, and you have the means, do it. You can always stop if you notice wokeness creeping in in a damaging way. I wouldn’t let this stop me, it’s just the symmetrical counterpoint to “friends/family can have toxic beliefs”.
Counterpoint: therapists (as a profession) *should* be ready to handle you wherever you are to get what you want out of therapy. If you are worried about it, tell a prospective therapist at an intake session. If they freak out, you know you need to look elsewhere.
As far as I've understood and experienced, therapists are not there to engage with the object level of your beliefs, unless 1) you bring that up yourself, and/or 2) those beliefs are disconnected from everyday reality enough to prevent you from functioning in the world.
Therapists are trained to help you "integrate" yourself, ie. diminish the amount of internally generated suffering and wasted energy from different unconnected patterns within your (mostly unconscious) mind fighting amongst themselves. That includes patterns left over from past trauma, but not only that.
The sign that therapy could be of help to you is that, when you look at yourself a bit soberly, you notice that your mind (or body) is often *compulsively* drawn to things you wouldn't want it to be doing, which do not feel helpful to your own goals and life.
That's a skilled job btw, not just something that a supportive friend can necessarily do. OTOH, some people are natural born therapists, and statistically, some professional therapists will be bad at their jobs.
Make so little money? The cheapest therapist in my area charges $125/hour and has no employees to pay. The average therapist in my area charges twice that. Unlike doctors most of them don't have to deal with insurance companies or managing any employees, and don't need to spend as long in school. Being a therapist seems like an attractive proposition if they like talking to people about their problems.
How so, I would think "long education, hard work and little material profit" is far more compatible with a desire of pushing an ideological agenda than anything else.
Mind you, if you are true believer®, the desire to push ideological agenda rarely feels like pushing it, it feels like helping people to see the light and live good life. Ask any religious missionary.
I speak from having been a mental health counselor. I went to college and my best grades and most interesting subjects were Psychology. I got out and looked for a job in marketing but with a bad economy, I could only get a counseling job. Then I didn't want to move up to be a supervisor because I wouldn't enjoy it. My parents paid for college, so I didn't have to think only about pay. And, being a woman, I thought if I had kids, my husband might make more money than me, so I continued. So, we may not get into counseling for a political agenda. Though, high morals vs helping a client hopefully would be covered in the studies because this would be a tough one without help. So blame the education if anyone.
Right. People may feel constrained in what, how, when, where they say things to friends. They want to keep their friends. We may need more of a friend's time than they have available for us. They may also be friends with a person we need to talk about.
Even if they don't, you may not want to burden them with the details of your problem. I tell people that therapy is the one place you can have a completely selfish conversation. After reading this I suppose your internal monologue is a second place, however it's easy to believe that one's internal monologue may not be as good at it as a therapist.
I'm not sure I have anyone beyond my wife who I would feel comfortable with/able to discuss my deepest issues with for 45 minutes a week. And people who are mentally unhealthy probably disproportionately have friends who are also mentally unhealthy and might not be able to give consistent calm good advice.
If I'm thinking about what *makes* someone my friend, it's that I'd be willing to take on that burden for them, and I'd expect them to be willing to do the same for me. If I didn't have anyone to turn to in a difficult time, I don't think I'd have friends, just acquaintances.
I agree, but do note that when a friend is distressed and need to work through their issues, being 100% honest with them *without emotional filter appropriate to their mental state* is often destructive. That is, emotional support can often be work. Often very hard work that leaves you exhausted. In the past I encouraged a friend to go to therapy because I found myself too stressed out to give them the support and calm advice they needed. That also something friends do, and I'm happy that I live in a society when we have professional help as a legitimate option. Even if it's partly a symptom of people having less close friends, I think it's also a consequence of people understanding it's ok to ask for help, even if their friends can't provide all of it.
Hmm, I think there's *something* to be thought about with the phrase "in a difficult time".
I've never been or felt the need to go to therapy but it seems like there's a difference between what somewhat would go to therapy for and what someone would call having a difficult time.
I think of therapy as being more for ... chronic (?) ... problems and going to a friend when you're having a difficult time as more of an acute/recent/singular issue.
I tried to be that person for my first two in-person friends after my first run at college. I ended up with severe depression and anxiety for a decade, subclinical depression and anxiety for the following decade, and an aversion to offering help to people. The second decade of aftermath was less severe than the first because of a talk-based recovery group I started attending.
Of course, one of them had undiagnosed, untreated bipolar, the other had undiagnosed, untreated Borderline Personality Disorder, and I have autism. My experience may be skewed.
I would guess so. I've been in a similar situation but was already depressed when I became my friend's "therapist". Honestly, knowing I was helping someone probably helped me stay alive. Although they also ended up seeing a proper therapist for a while.
I think if we're debating "can friends be support therapists?"/"are therapists hired friends" then we should really limit ourselves the normal range most people fall into.
Indeed, if a friend came to me and straight up said they wanted to die and were aleady planning it, or thought their dead father was sending the CIA after them (a delusion I have actually experienced haha), that would set off my outside-normal-range alarm and I would tell them to go to get help.
If it is a burden to them, they aren't friends in my book. The kind of people you are talking about are acquaintances to me. Friends are something you usually don't have that many.
Friends are those people you can call at 3am to help you and they will. You are lucky, if there is one such person in your life, let alone multiple such people. There are probably not that many people you'd do the same for. But those are friends.
A "burden" isn't an objective fact, but a subjective description of something. I stand by what I said: if it is a burden to them/or to me, we aren't friends.
If that's your definition of "friends", then I can't say I disagree. But if that's going to be our definition of "friends", then an awful lot of people don't *have* friends and there's basically no place in our society where you can go and say "I don't have a real friend; can I maybe rent one?" or even "I don't know how to make real friends; can somebody give me lessons?"
Except, to some extent, therapists. And a few other niche cases, but you can't count on those being available in any particular instance whereas therapists are omnipresent.
I'd agree, many people don't have friends. Some, because they themselves are too shallow or too selfish. Others, because they simply didn't find a match.
I have two friends in my life. And surprisingly they aren't the two I had imagined would be my friends when I was a kid. Some lessons really hurt to learn.
True friendship only reveals itself when tested. That doesn't imply that one should force this test. Someone who could have been a friend would probably consider this abuse.
That might be exactly the problem people are describing. It seems increasingly that people can't/won't/don't form friendships, either from lack of ability or lack of place to meet and bond with them, etc. There is likely always going to be a certain percentage for whom therapists are necessary, either because they have persistent problems, or need close friends they can't get (or maybe they need help because their only friend was just caught in bed with their spouse). It is also possible that we are seeing increased therapy demand as people who need a friend go to therapy because they don't have a friend available. My guess is that the increase in demand for therapy is just that substitution effect away from friend to therapist, not driven by an increase in people for whom a close friend or confidant would not be sufficient.
Then again, I would be sympathetic to arguments that something we are doing is screwing people up more, such that they both are less likely to have close friends and more likely to need therapy, friends or not.
There is an enormous difference between happily helping your otherwise competent friend at 3 am when he is in trouble once a year, and helping someone who does that twice every freaking week.
I have helped a lot of people when they were in trouble and I would gladly do it again.
But there are people out there who are truly broken: if you start supporting them, soon you will notice that you lose 10+ hours per week just treating their emotional baggage, grinding down your own mental state and - worst of all - seeing no permanent improvement on their side.
There is time when you have to stop playing Prince Myshkin and eject.
It really depends. If any of my best friends called me at 3:00 a.m. really desperately needing to talk, of course I would do it. If they called me even twice or three times in a row at 3:00 a.m., it would start to be a problem. If they called me every single day at 3:00 a.m., it would jeopardize our friendship. At some point I would lay down a boundary that I need my sleep and I would stop answering the phone at night.
If someone has a very chronic issue, then talking about it constantly, especially if they aren't making any progress, is burdensome on their friends. Also, if one person has a chronic depressive issue, that usually means that their friends will try to avoid placing extra burden on them, which means the relationship is no longer reciprocal--we're both carrying each other's burdens--because one person is overburdened and trying to unload their burden on everyone else.
I fully agree with what you wrote about friendship. But I feel as if, what you probably perceive as adding nuance, was actually an attempt to steelman what I wrote.
In my post nothing said 3am each and every night. Balance is the key to real friendship. But this balance doesn't need to be achieved instantaneously. Friendship isn't exactly trading either ...
I think most people think of therapy as treatment for chronic issues, is the thing. The people who need therapists the most are people whose friends can't tolerate their level of emotional neediness.
I personally see things the opposite way: we are friend because at one point we asked the other person for time and emotional commitment, and we gave it. This is a restrictive definition of friendship but I'm fine with that, there are lots of people that I'm friendly with but that I wouldn't consider "friends".
I also think it's very important that it goes both ways, find some kind of equilibrium. At some point in my life a friend really needed me, and later I really needed them. That's how life goes. I was here for them, they were here for me. That's what friendship is to me. Sharing the good time, helping each others in the bad times, trying to not depend too much on them but also be ready to depend on them a bit if you really need it.
People are saying that we should be willing to help our friends, and I agree—but I also recognize that I rarely befriend highly dysfunctional people, the ones who need the most support, in the first place. And I suspect I'm not alone in that.
Right. There are people who are very difficult to tolerate, very difficult to like. Those people probably disproportionately go to therapists/medical doctors/the nice lady st the library, because they need social support and can’t get it otherwise.
Or even people with great friends might prefer a therapist. I went to therapy to talk about my issues with someone who *was not a friend*. My friends knew my issues, but there was a conflict between how much time I needed to spend working things out verbally and how much of my precious social time time I wanted to spend talking about my mother. I needed that time and those friends free for fun!
My friends also are humans with their own baggage. I couldn’t necessarily talk to the friend with a terrible record for relationships about my boyfriend, or the fatter friend about body image. The friend with a totally deranged mother was wonderfully supportive, but I always felt guilty complaining to her about my only-mildly-crazy mother.
By contrast, I really felt like I could say anything to the therapist. Besides, I was paying him to listen to me! That was incentive for me to be thoughtful and honest, and the whole thing was actually helpful even if it wasn’t life-changing.
Strong disagree. If it is one sided yes, but if there is reciprocity and two-way interest in the emotional well being of a friend that that justifies - demands even - burdening each other with potentially heavy emotional baggage, and this is one of the things that differentiates friends from "friends" (whatever exists between acquaintance and true friend)
It seems to me if you aren't at least occasionally burdening someone you might never reach that sort of true vulnerability and rapport-building that forges dramatically valuable relationships
"occasionally burdening" is one thing. Dealing with a chronically depressed person is "consistently burdening," however. And incredibly frustrating because there is usually little or nothing you can do to help. It's a sad fact, but depressed people who needs friends the most are often nearly intolerable to be around.
I think that's missing, inadvertently, one of the most important parts of most therapy - the therapist generally isn't in the business of giving advice. Calm, good or otherwise. They are paid to listen! Actively, empathically and where possible, encouragingly.
Most people are unable to do this - they can't help giving bloody advice, which is the reason for the splashing out on therapy.
If people don't have friends that can give them a damn good listening to, a therapist may be the only option.
Therapists shouldn’t give “advice” in the sense of “yeah I think you should take that job” or “leave that relationship” but they SHOULD bring expertise and perspective to their clients that couldn’t be found in the average person. They should be obviously well versed in different theories and the science behind what drives human behaviors. Their job, in my view, is to help you understand your thinking (and subsequent emotions and behaviors) and the reasons behind it more clearly, so that you can decide which actions to take for change. Their job is not to tell you what to do or solve all your problems for you.
therapists should more objective and less biased than friends are. Your therapist shouldn’t have any preconceived notions about what kind of person you are or what your family is like a friend would.
Different therapists will have different approaches to how to handle this, and some may even give explicit suggestions when solicited, but I think that in a lot of cases if a client asks a therapist "should I take this job?" or "should I leave this relationship?" the therapist will not only have their own opinion, but try to guide the client around to it. This may or may not be a good thing depending on the therapist's judgment, but a good therapist will have experiences with a large client base to draw on in terms of how various life decisions have worked out in different situations, so giving effective advice to a wide range of people could end up being something they have domain expertise in.
IDK. I would think a good therapist would help the patient to work through the question of "should I take this job?" The therapist shouldn't care about the particular answer. They should care that you are able to make considered decisions for yourself.
I think different therapists will have different views on what a good therapist should do in a given situation. I think that therapists who most people consider to be good will do their best to guide patients to make decisions that the patients will feel better for having made, rather than prioritizing the therapist's own preferences. But if a therapist thinks for instance, that taking a particular job will probably make you much happier in the long run, but that you consistently struggle with impostor syndrome which makes you feel unqualified for anything you do until you've been doing it for about a year, so you're probably going to be strongly biased in favor of not taking it, then I think a lot of therapists are going to see "guide my patient towards taking the job" as the desired outcome, so if they lead you to carefully consider the matter according to your own judgment, and you decide not to take it, they'll feel they've done a suboptimal job.
If a therapist thinks that some decision is most likely best for your happiness, but you're biased against it due to known habitual flaws in your reasoning, then for them, "guide my patient to what I see as the most favorable outcome" and "guide my patient through their habits of reasoning to uncover if they have biases hampering their judgment and holding them back from what makes them happy" will likely be equivalent.
Some therapists clearly inject their own biases and priorities into their guidance quite a lot. For example, I've heard a lot of people recount stories of devoutly religious therapists pushing their patients to conform to their religious views. Presumably, some therapists are going to be more or less committed to pushing their own viewpoints on their patients. But for some patients, the ideal therapist might not be one who doesn't push their own viewpoints at all, but one who exerts a comfortable amount of pressure pushing them towards decisions that actually make them happy.
Agreed and understood. But a corollary - when demand for therapy goes up, it likely indicates and is responding to a decrease in close social connections, a decline in healthy marriages, alienation from family... I'm not criticizing people for seeking a substitute. But I wish the *real thing* weren't in short supply, which is what I see as provoking that response. (cf. Bowling Alone.)
I'd argue that if we look at modern specialized professions, then the traditional small parish priest was effectively doing many of these jobs he was effectively the psychotherapist and marriage counsellor, and the traditional rituals of catholic confession IMHO effectively are structured therapy frameworks.
Seconding this! I think in particular men have trouble forming close friendships, and end up leaning far too heavily on their romantic partners, which makes men who are single (as especially the ones who have just ended a relationship) especially isolated.
Oh I don't know. I think there were many dysfunctional relationships in the past, people just didn't acknowledge them because it made them uncomfortable or bad relationships were gauche.
I absolutely do not think marriages were healthier in the past, there were just more cultural norms to stay in them no matter what. Etc.
Good therapy is not about advice though. In fact, if a therapist is giving lots of advice, it’d be fair to say they’re probably not a good therapist.
Also, there are probably things that you (or anyone) wouldn’t feel comfortable telling your wife- and maybe, or especially yourself, that may actually be at the root of your problems. I think people often think of therapy as a means of getting answers or advice, but often it’s the exploratory process of actually figuring out what the issue is that is most illuminating/helpful in therapy.
If you can't tell yourself how can you tell your therapist? Or are they supposed to be so penetratingly good at their job that they divine these things themselves? That seems like the sort belief that can lead to disillusionment with therapy when you realize that a therapist is just some guy/girl (and not only that but they have 50 other patients and you have spent 1000x more effort modeling yourself than they could possibly ever do)
I've gotten precious little benefit out of a bunch of therapy, but when it was helpful it was never about 'insight' but an external 'professional' agent giving me obvious (but correct) advice which gave it more weight than when I told it to myself. Sort of self-help placebo
I don’t think it’s that they give you the insight, and certainly not that they divine them. They have no special knowledge per se. They are trained to listen and in a method to help guide you to arrive at the insight on your own and together with you. Ideally you’re the one arriving at the insight b/c that’s when it has the potential of leading to lasting psychological change. Giving you the answer won’t effect change in you. It’s a dynamic exploratory process, and (in the more psychodynamic traditions) helps uncover the Unconscious which can be illuminating and helpful at understanding, and at times changing, patterns of thought and behaviors
A good therapist can ask the right questions at the right time because they know how to listen. That’s how it’s possible for you to tell them things you don’t really understand about yourself and why you may be doing things that make you unhappy. Then they can explain to you what they heard, and that can make it easier for you to hear and understand yourself. At least that has been my experience.
That's kind of weird to me, though. The only reason I would go to a therapist would *be* to get advice. I'd see it as like going to the doctor: hey, doc, I have this and that symptom, this pain here and a soreness when I do this -- what does it mean? What should I do about it?
And I'd kind of expect the therapist, like the doc, to say well Carl that seems like a textbook case of Fnord Syndrome, first described by Dr. Whozit in 1899 -- here, let me show you a gruesome plate from my medical textbook -- and I've seen a dozen of these cases in the clinic over the years. Best modern idea is that it's caused by excess hair on your glial cells and the best treatment is gargling twice a day with licorice tea while saying four Hail Marys. Also, stop dating brunettes and give redheads a try.
And I would say thanks! doc and here's $100. I mean, if the guy doesn't know far more than me about how the mind works, and can't give me insight beyond what I can originate myself, then I'm wondering why I'm paying him good money for his education and experience.
I realize this is a caricature, and maybe this is what a good therapist actually does, but by some subtle process of steering me in the right direction in such a clever way that it seems like I stumbled across wisdom on my own, but I would find this tediously circuitous. Why not just shoot straight to the point, tell me what I'm doing wrong and how I could straighten it out? I wouldn't *be* there if I wasn't willing to listen, if I didn't think I'd come to the end of my own abilities to generate insight.
Being willing to hear someone out is very different from being willing to change. Often, the correct path is obvious and everyone gives the same advice, but actually getting someone to break a bad habit is very hard, and is quite dependant on the presentation of the advice.
I guess. I've seen others react that way. I mean, I suppose I'm just saying I'm not a good candidate for therapy, but I'm doubtful that would work well with me. I already usually rephrase internally whatever anyone else says to me into my own language -- like a mathematician always rewriting polynomials into standard form. So it would not matter how the advice was presented, since I would always internally reduce it to the same canonical form anyway. And it would annoy me if someone was clearly trying to be elliptical and diplomatic. I far prefer plain speech -- if it's unwelcome news, I prefer to hear that bluntly rather than delicately. But other people aren't like that, I know, so I get the need.
The problem here is that what you should do (and the reasons you’re not already doing it) in any given situation is contingent on too many particulars of your interior experience for another person to simply diagnose.
A woman I’m seeing has a fraught relationship with her father. He invited her to go on a trip to Nashville and putz around for a few days. She’s torn about it. Should she go? How many questions need answering here? Why is the relationship fraught? Is it rectifiable? How much does she intrinsically value familial bonds? What is the risk that the trip will be good/unpleasant/emotionally destabilizing for weeks? Who can answer these questions except her?
The utility on offer is having another person help you discover these questions and your own answers to them.
People in technical disciplines do this kind of thing _all the time_ - you get together with Frank and discuss how to design Foo to meet all of the constraints, because having another brain modeling the problem speeds things up substantially.
Unlike in technical disciplines, though, we’ve got a bunch of gremlins in our brain that often want to actively deceive us about what’s happening in our lives (and how we’re playing a causal role). Often our values are misaligned with our behaviors, or we’re acting out some patterns of behavior that are difficult to notice from inside of them, and we’ll react negatively to anyone directly pointing it out. So therapists sidestep those defenses with empathy and questions
Sure, I understand nobody has the particular to help with some detailed decision or other, but what I would want (if I asked a therapist for help) would be help with *how* to make the decision, and that *should* -- if psychology has any meaning at all -- be something fairly universal, tied to the nature of the human mind.
So in your illustration, presumably the therapist could listen to *how* your inamorata was planning on making that decision, and advise her where her decision procedure was good or bad.
I understand all your last paragraph except the idea that someone could (1) be motivated enough to deal with the gremlins that he decides to go tell a stranger intimate details *and* fork over good amounts of time and money, and yet (2) would "react negatively to anyone directly pointing it out" as you say.
By me that is almost literally insane, violently self-contradictory. You want to get better or not? If you do, and you can't do it alone, then pretty much by definition you're going to have to hear and accept things that are unpleasant and which don't immediately strike *you* as plausible (because if it were either pleasant or plausible to your own ear, you would have already said and accepted it on your own).
That is, the only reason I would go to a therapist is because I thought I needed to hear something unpleasant and strange to my ear, some kind of kick in the ass that would get me out of the rut of my own thinking. So I wouldn't *do* it unless I was fully prepared for that. I mean, if I go to the doc for a funny wart, unless it's meaningless I expect he'll say "dear me, this is going to hurt as we cut it out, but you'll be better afterwards." Why would I expect the head doctor to be any different?
I mean, it’s not entirely sane, but see e.g. drug addicts who swear they want to get clean and then go do their drug of choice. They’re not a special category, the level of dysfunction is only really special by degree. The reality of the human condition is that we’re not coherent, rational actors. This is what Scott was writing about when he did that exchange with (maybe Caplan?) about mental illness as a revealed preference or whatever.
If you can’t identify places in your own life where you want two things that are mutually in conflict and this has lead you to act out incoherent strategies, odds are you aren’t looking hard enough.
Also, surrendering your judgement to others isn’t a viable or safe path out of dysfunction: this is how people end up joining cults. If your worldview is badly distorted and you can identify that fact, it doesn’t necessarily mean you can just stop it.
You might be interested in “motivational interviewing”, which is a therapy technique for influencing people in the direction you think they should go while still leaving them with autonomy to make their own choices
I work with a lot of men and many of them do better meeting once a month or on an as-needed basis because they don't have the same volume of material (some do) or the same needs to sort things through relationally. Often men only come to see me because they have run out of other options (mom, wife, girlfriend aren't available or helpful) or because one of those women have asked them to talk to someone because they are worn out from carrying the emotional load of the man in their life not having a wider array of emotional supports. This isn't to say anything about you obviously, just something I notice about the difference between many of my men clients and many of my women clients.
FWIW the Venn diagram of people I used to frequently drop acid with, and people I'd feel comfortable discussing deep issues with, is a circle.
Discussing them with your romantic partner is perhaps not a great idea, given that a lot of these issues are either relevant to your relationship (so even talking about them changes the situation, in ways hard to predict) or just scary and unwise to inflict on someone who cares about you the way a spouse/long term partner should.
Personally when I tried therapy, I didn't feel comfortable talking to a stranger about these things and spent the whole time lying / managing the therapists perception of me. Predictably I didn't find therapy helpful
In the end, depending on the problem, I feel more comfortable talking to my family, my spouse, strangers on the internet with similar problems, and close friends. There are occasionally things that are too private even for that, and they go in a private journal instead.
What about group counseling and "support groups"? It seems like an awful lot of people just need some social contact and a sense that they aren't irredeemably defective. Nothing too fancy or expensive.
I use therapy like how I hear some sex-work patrons use sex-work services. There was an initial hurdle to overcome, but once I was past that it was kind of nice being able to discuss those deepest issues with someone who didn't have the perfectly normal, healthy desire to have a symetrical relationship with me that a romantic partner or friend would like to have.
Historically, this role has been filled by religious leaders and phylosophy tutors, and by no coincidence I've availed myself of their services in the past for similar interactions.
I've got a deep pool of healthy friends and and a great relationship with my romantic partner, but having a transaction interaction isn't possible with them and sometimes its just the thing I need.
Also: some of us have mental health issues that make it difficult for us to make and maintain friendships, and give us problems that are hard to talk about to people who don't have experience working with neurodivergent types.
Same here - guess is even more like 45-90 minutes each day with the wife...
That lets me start thinking about some men's claim, that marriage would be to expensive for the personal gain they get from having a wife instead of just a girlfriend or friend with benefits or similar constellations. These men could account the 'cost of having a wife' with the saved cost for a paid therapist (300 per week, 1400 per month, 15000 per year, 0.75 Million per life)
I think you could be reading too far into those words. I didn't mean to imply a moral duty, or assign blame. I'm just saying, it is good for people in so many ways if they have human relationships; it's lamentable that such relationships seem to be in decline; and I don't think therapy can fully make up the difference.
100% agree with you there that therapy cannot fully make up the difference. Also that it's not designed to, and so all the more important that it not be seen as trying to.
It’s not supposed to. That’s not what therapy is. It’s not a substitute for something else, it’s talking to a qualified professional who may be able to help you figure out why you feel certain ways. I talked to my friends about my problems for years, and I still do, but my friends weren’t qualified to refer me to getting diagnosed with Bipolar II and ADHD, something that happened way too late in life for me but might have happened sooner had I gone to therapy. My friends also aren’t qualified to help me recognise and deal with automatic negative thoughts, or to provide me with coping mechanisms when I get too low to do much of anything. I still talk to them and they still listen, and they talk to me, and we all support each other. But sometimes you don’t need a friend. Sometimes you need therapy.
I wonder if "cultivating a network of friends with whom you can exchange informal but high-quality services, such as tech support or therapy" could be one of those useful milestones/life skills that makes therapy more useful for some people than others.
I think it's a lot worse with women for a bunch of social reasons - every woman I seriously dated had basically no close friends (to be fair introverts are my type, but come on). This would explain a LOT about the "men would rather..." meme, we just go out for a beer then inexplicably end up spilling our soul to a friend in the morning.
That is almost the opposite of my anecdotal experience, that women discuss emotional issues and mental health with friends all the time, whereas it's very rare for me to do so with my male friends - I can in a crisis, but it feels very vulnerable in a way that talking about that stuff with female friends does not.
If we could get a person who had formal training based on science, a mentored internship, and a decade of practice, then a friend's aunt would probably not be the best choice. But give me a mature elder who sees working with troubled people as part of their life work and who approaches the relationship with humility and affection over a first year college grad any day.
Local person seems to have a serious advantage in being embedded in your community. They might have more skin in the game because of this, and they have the advantage of actually experiencing many of the same situations you do (though through possibly very different eyes). Therapy feels designed to be *not* very overlapping with your day-to-day life (maybe this is somewhat of an illusion??), which could have it's own advantages (e.g. if your day-to-day life seems fucked up, with no one to turn to).
This is my first comment on SSC. I have enjoyed reading Scott for years but prefer to lurk.
But coming across this post right now makes me feelmlike I ought to have the courage of my convictions.
I've spent a few thousand hours visiting the elderly, lonely, ill, crazy.
And at times I arranged to help others to do the same.
As you can tell by the handle I'm using I'm ambivalent on whether I'm actually interested in being taken seriously in the public sphere these days or not.
But I posted the following tweet today with serious intent. I've matched up the helpful with the needy before and I would guess need is no less now than before.
So even though I preferred my first post before Great Scott to be more polished under a more inspiring nom, if I don't post this now I will definitely rationalize not doing so.
You know the old joke about how clients don’t pay prostitutes for the sex, they pay them to go away afterwards? Well, therapists can be a bit like that. Sure, my friends will listen to my troubles but then I have friends that heard my troubles! Paying someone who I don’t otherwise have any contact with can be useful.
There's a level of friendship at which it won't bother you at all that they've heard your troubles. It's rare- I only have 2 friends that I'd tell *everything* to.
It's often the case that I need to dump a lot of HARSH shit on someone whose job it is to hear that sort of thing, and who has the training and experience not to take it personally. That's not necessarily the easiest thing for a friend or loved one to hear.
I generally agree with your idea that the loss of social bonds is a bad problem, though.
Another angle to remember is that a lot of people *do* have a supportive community they can talk to every day and get support and advice from, and that community is qAnon.
(Or whichever other extremist/stupid/dangerous community is your personal outgroup boogeyman.)
Therapists aren't *just* someone you can talk to, they're someone with certifications and training and education. If you're surrounded by smart and empathetic people with lots of time and compassion to talk things out with you, they may be better than the average therapist; but the average therapist is probably better than the average friend that the average person could talk to.
To quote the article, we're talking about "supportive therapy", which is "unstructured talking about your feelings and what's going on in your life". I honestly don't think you need any kind of occupational training to provide value by doing that. And what's more, I think the best, most helpful version of it will happen with people who actually know you, not with people you've paid, regardless of how good their training is.
That depends on whether you have a mental illness or not, or trauma to process. I don't think your friend is necessarily going to be able to help you process trauma as effectively as a therapist, no matter how willing they are to be there for you and listen and take you seriously. "Supportive therapy" has structure and theory and modes of practice that a good therapist will adjust based on your needs, not just free form talking without any underlying method.
This presupposes that these trained specialists are actually helpful. Increasing numbers of therapists and school counselors does not seem to have corresponded to an increasing level of mental health in the US.
Yes it's very sad that most people don't have deep emotional connections they can talk about anything with but it doesn't make it any better to say that. This is kind of like saying everyone 'should' have loving homecooked meals whenever they want them, instead of having to go to restaurants to have a stranger cook for them.
I think identifying the problem is an important part of finding a solution. I think most people in this thread chiming in about their personal experiences with therapy have said they've gotten something from it - great! But for the others who haven't, for any of the various reasons I've seen, we should try to understand how else we might be able to help them.
Also, if the increase in demand/provision of therapy is caused by a lack of emotional connection, that seems... significant? Worth remarking on? It's the kind of thing I come to this blog for, trying to get a little bit better of a lens into how the world works, even when it's not all that actionable.
Therapy is much more than that. Some people can benefit from professional help from psychologists who have deeper knowledge of the issues they are going through. Talking to friends and family is not going to cut-it, instead, it needs to be a professional with deep psychological knowledge.
For example, I had a lot of insomnia caused by anxiety related to my life's issues, which include the fact I am asexual and I work in an extremely competitive field. Talking to family and friends for years only made it worse, then I talked to a PhD in psychology and combined with SSRIs, made an enormous difference.
Don't know about others, but there's at least a few things I get out of therapy that I can't get out of normal human relationships. The obvious one is relationship issues themselves; complaining within a shared social circle is likely to have unwanted side effects, and as a relationship's duration lengthens, fewer and fewer acquaintances are not shared.
(in recent years, meta-politics has become a recurring theme too, because of universal politicization coupled with almost everyone I love going politically insane)
More generally, therapy provides a context in which I can speak without having to vet my words for impact first. I can make statements that are denotative without being enactive. It is slightly more possible to Just Say What I Mean[^1].
The part of this I find disquieting is that if you talk to your friends, they have an option to walk away or not put up with your bullshit if you are too self-centered, or just seem interested in validation and not *really* solving anything. That kind of cold water in the face can be useful, assuming you aren't too narcissistic to interpret it correctly.
But you can fire the therapist, and the therapist is motivated -- at some level, depending on their inherent ethics and level of financial need -- to avoid pissing you off enough that this happens. So it's possible for people to simply hire therapists[1] as courtiers, who will for $100/hour tell you that you're pretty much OK and you don't, in fact, need a kick in the ass to stop being such a jerk.
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[1] Admittedly we would not call these very good therapists, but I'm confident they exist, because I've known people who shop for them, and they do find them.
Oh, they definitely exist, and it's all too easy to end up with that kind of therapist even if you actively don't want to.
I've been to therapists a few times, usually prompted by "I can't stop doing X and it's destructive, please give me advice to help me stop" and they always just metaphorically pat me on the head and tell me I'm doing fine and I should stop beating myself up about it.
I knew someone very well who was in that boat. She went to new therapists hoping for the best. "I already *know* I shouldn't do this, and at some level I want to stop, I just need some practical advice on how to do that." Like she wanted tips 'n' tricks, ideas for mind games she could play on herself that stood a better chance of working than those she could think up on her own[1]. She didn't think much of root causes analyses, because she'd say that's all very interesting academically, but I have a practical problem here, and knowing it got started with this or that experience when I was 11 doesn't do me a damn bit of good solving it.
Unfortunately she never really did find anyone that she thought had anything useful to say, and by and by she stopped trying. She got a grip on her problem on her own, more or less just through enormous strength of will and patience. She ended up being pretty disapointed in therapy per se, though.
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[1] I should say it was her notion, reasonably proved correct by her later experience, that all she needed was to establish a new habit, just *not do it* for a certain length of time, and then the need would dissipate. Sort of like quitting smoking.
I often find myself in this position. I know what can fix my problems and achieve my goals; my issue is typically only ever *doing it*, as a matter of motivation and focus.
That's fascinating. But unfamiliar to me. I don't really have a problem doing stuff I decide to do, even if it's painful or tedious. I'm quite capable of driving myself until physical collapse[1]. The problem for me in not getting stuff done is always not enough time or equivalently too much to do, overcommitment, or an OCD unwillingness to let something go when the return is diminishing to zero.
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[1] Although there's no doubt a healthy slice of pure luck here, because I have never had to recover from a meth or crack habit, for example, which put far greater demands on the will than anything with which I've had to cope. I've never been shot at, either, and had to stand my ground or even advance. So I'm a long way from thinking I'm any better than guys who *have* had that challenge and buckled. I might, too.
We don't have a lot of control over the families we are born into, that's the only family we know, and its hard to see into the intimate mechanics of other families. So, if your family is really messed up, you are probably not receiving important aspects of development, and you don't have the capacity to know what your missing.
I went to therapy because my parents are socially stunted people. I don't mean that in some glib, liberal, snotty way. They both faced social and financial poverty as children, and missed forming important social or emotional skills. I grew up in a house in which I was functioning way above my age since I was very young. Not only did I have to take care of myself, I often had to take care of my parents. Sounds really messed up - but I didn't know that! I was miserable and isolated because I also struggled with social relationships, and I couldn't know why (my parents never talked to me about relationships, just told me that all people were bad and disappointing). I tried to talk to lots of people about my parents, but there are very, very strong (I can not emphasize this enough) cultural norms about ungrateful children, suffering parents and respecting elders, so that many peers and adults will shut down those conversations. Which is to say, I repeated reached out and was denied.
I was lucky in my mid-twenties to go to a therapist. I was able to learn many social skills that I missed as a child. I learned how more typical, if still imperfect, families worked. I unlearned the norm that I had to be close to my parents no matter what, and learned about families that had broken dynamics. I chose a more distant, but more functional relationship with my parents, and I learned how to navigate that, as I didn't have a model of how to do it, and since my parents and society put constant pressure on me to act differently.
Its truly shocking to me, that although I have many Woke and pro-therapy friends that use therapy chatter all the time, that there is still this undercurrent of judgment for not getting along with my parents. Even with good friends, I still have to pull my punches and mostly talk about the sunny side of how our relationship is better. People do not, and willing will not, understand. Most people don't like to know ugly things.
If I had not gone to therapy, I'd be miserable. I wouldn't understand why my work relationships were always so challenging, I'd consistently choose poor dating partners, and I'd have the same relationship with my parents, which made me miserable. I used to have very low self esteem. Everything changed. I'm so glad I went.
Near the end of 8th grade, I wrote a suicide note to a teacher. I had no intention of killing myself, but this brought the full force of the District Psychologist to bear on me. While the school called my mother (a worst-case scenario for me), this man walked around the outside of the schoolyard with me. He told me that we can choose our feelings and responses to things, and can choose to feel better.
I know from having lived in the world for a few decades that this is terrible advice. No depressed person needs to hear this. Universally unhelpful.
That advice CHANGED MY LIFE. I gave it a try...and it totally worked. Between 8th and 9th grade I went from a kid who cried almost every single day to being pretty happy and cheerful. It was a total revolution in my feelings. I mean, what?
All cliched useless advice is great advice to the stupid person (or 8th grader) who has never heard it before. Somewhere in the deep forests is some guy who has heart disease but has never heard he needs to eat right and exercise, And if you told him he would be delighted to learn there was something he could do, and he would never eat fast food again. Everyone else has to hear "eat right and exercise" partly in the hopes of catching that one guy.
I have to admit to a lot of respect for that guy in the deep forests who still manages to live off of fast food. Here's to you, Jack-in-the-Cabin Man. (raises travel mug)
That's part of my idea of why therapy works: it provides people with mental models they don't have yet.
Lots of what you write tiptoes around this, btw. The review of the Bicameral Mind most of all, or how you said something about CBT not being the best anymore because it's already in the water supply. Wonder if it's because of your clinical experience.
The obvious alternative to therapy is just culture: you get those mental models through interactions, conversations and, let's be honest, the lion's share would be consuming media. Which means a society's media is a lot more important and useful than it's usually given credit to.
The next obvious step would be designing stuff specifically for teaching concepts, like EY did with HPMOR. I have no idea how widespread doing this deliberately is, as opposed to concepts just randomly ending up included in various works.
I think there are lots of things people have heard before but haven't updated enough on. Rehearsing the obvious could help with that even if everyone had already heard it. Religions are constantly encouraging people to re-read the same text. I don't think this would be a universal feature of religions if it didn't accomplish something. OTOH schools don't encourage students to re-read the same text unless they're studying for an exam.
I imagine an alcoholics anonymous meeting has the effect of constantly rehearsing "alcohol is bad" and "we try not to drink anymore" and "we support each other", with moderate effectiveness. Sometimes people really need to hear things again that they've already heard.
I like the zen book example: You have a broken teacup. You can be happy or sad, your teacup is still broken.
Sometimes a stranger's advice can help. And some people know just the right thing to do or say when they see a problem. That particular person might make a very good therapist. Anyone who is not as lucky as you could pay a therapist in their office. Paying makes you take things seriously. As a mental health counselor, a neighbor called me to say her daughter has tried to commit suicide. What should they do. I said call an ambulance and have her taken to the hospital for an evaluation. That turned things around. The girl had to decide at that point if she was serious about living, serious about being labelled mentally ill. She chose to take control of her life and find something good in it. And not make her parents pay for another ambulance ride.
Is it possible that the difference between the 8th grade you, and most depressed adults, is explicable in terms of something like an accumulation of evidence _against_ the proposition "i can choose my feelings and responses to things?"
I use a 'higher resolution' of this belief, but it's much more like "over long periods of time, i can choose how i feel, which i do by changing the outermost narrative frame i use about my current state, and then after some period of time, my emotional state follows."
The more often i repeat that practice, the shorter the time period it takes for me to adjust my emotional state. So now i'm at a place where hearing 'you can control your feelings' really DOES work. But i think what a lot of people hear is, "you can control how you feel in each moment with 100% accuracy," instead of something like "your emotoinal state is ike the momentum of a large object; you can exert some force on it on that object, and, over time alter its trajectory."
Yeah, this totally makes sense. Also, I didn't turn out to be a depressed adult. Did I get just the right advice at the right time? Or am I just not prone to depression and was just momentarily stuck in a cycle of sadness (I mean, middle school, you know) that I was able to snap out of?
I find I often can snap out of feeling bad by a smallish act of will. I'm sure this is like how some people can remain slender by just "not overeating," while others of us are fat, and not for lack of that simple advice.
I prefer the framing of reality tunnels (Wilson/Leary) - you live in a world of your own design that's based on an objective reality somehow but that doesn't really help. Choosing a frame in which you view an event is way more powerful than choosing your response (which is artificial and to be honest, other layers of your mind know you're full of shit).
Biofeedback is great. If you just make the face that you would make if you felt a certain way, you start to feel that way. I use this often. Plus lots of fresh air, exercise, and a healthy diet. I'm the only one out of six adult descendants of my maternal grandmother who doesn't seem to strongly need antidepressants. But I'm about to start 150mg of bupropion XR anyway, just to see if that makes me even better.
When you say biofeedback, are you talking about a digital fitness watch for example? It takes a lot of time to get fresh air, exercise and healthy diet, so it means you are in control and taking care of yourself. You are not letting your time go to excess work or other demands. You are living within your means with a healthy work/life balance which it not easy to achieve. I applaud you for setting limits. I have taken Bupropion XR and it helped when needed. But I also found that when I was not prescribed it and had a few extra pills, I was able to get the placebo effect by taking only one pill. I reached for something to make me feel better and soon I was better. I did this several times with the same good results. Glad I didn't try dangerously addictive drugs instead !
So I've taken the second dose of 150mg of bupropion XL (the smallest pill they make) and I already noticed a big improvement within an hour after the first dose. I have much more motivation to get things done instead of sitting around playing video games or watching TV. I've organized my closet, organized my social media, signed up for lots of social events, cleaned my apartment, and completed other annoying tasks I'd been putting off for too long. My sleep is still fine and my focus has improved so I guess I'm not manic? Maybe being normal feels sorta manic compared to how I usually am? There are no side effects worth mentioning yet.
All in all I'm really glad I made the decision to try it. Many people may not realize what they're missing, like a fish doesn't notice the water he swims in or have any concept of dry land.
It's possible it's not just the medication that is working. You know what you need to get done and know help has come. You're more motivated to help yourself now that you don't have to do it all alone. Good for you!
Growing up, my mom had a sign in our home that said "most people are about as happy as they make up their minds to be". I've been online enough to know that if I try to tell this to someone on the internet I'm signing up for a mob lambasting.
BUT for me, it's completely true! Pretty much every time I'm acting like a giant curmudgeon, it's because I'm making a prideful choice to be grouchy and could "snap out of it" if I just set aside my expectations of what I deserve and choose to be happy.
So we have some evidence for people who are "high" all the time. Basically some people are just naturally happier. So it might be the case that some people *can* just choose their feelings but many others can't and we all know how trying to treat everyone monolithically ends up.
The notion that this advice doesn't work is actually one of the Big Lies. It absolutely works.
Normal, mentally healthy people can indeed choose how they feel and how they choose to react to things. In fact, this is even true of most depressed people.
It's the first line of advice for anyone who is having problems because it turns out that you actually can control your own emotions and you can choose how to respond to situations. Understanding that you have agency and control over your own life leads to massively better life outcomes, and people who understand this do better in life than those who don't.
Indeed, a lot of depressed/anxious people are the same way - they can in fact choose how they respond to stuff, they just sometimes forget that that is the case. For some of them, their feelings end up ovewhelming them.
The people I've seen emerge from severe depression, it's basically them slowly teaching themselves not to go down negative mental pathways all the time, training themselves to not always feel bad/default to pessimism, understand that other people aren't out to get them, that everyone isn't about to turn on them because they said "the wrong thing", etc.
That's why the medications help, I think - it helps them not immediately go down the bad mental pathways and gives them space to "reprogram" themselves, so to speak.
People can choose to be happy, sad, or angry. They can choose how they react to these things. That's what makes people *people* instead of animals.
This is why phobias can be overcome as well - they can gradually be desensitized and learn that whatever the phobia is isn't actually harmful and dangerous. But they have to build up an intuitive understanding of it - it's not enough to say "it's silly that I'm mortally afraid of insects", they have to actually get it baked into them on a deeper level.
Honestly, I wonder if some people are simply inherently capable of accessing a "higher level" of self-psychological tinkering, and are simply never diagnosed as being phobic or anxious or whatever because they are simply capable of doing this on their own and overcoming that intuitive response and controlling and reprogramming it, and it is only people who have some sort of issue or deficiency that cannot.
It's worth remembering that many people don't experience PTSD after undergoing trauma; most people are just fine. It's the people who have problems that we remember.
I’m sure that talking cures can help people. However how much, if any of this, is down to the supposed founder of psychoanalysis Herr Freud? Has he been overthrown.
I occasionally watch Fraiser on syndication and he’s supposedly a Freudian - but when answering people’s calls it’s generic helpful advice, I’ve never seen him suggest that the caller’s problem is his love for his mother, his death wish, or her penis envy.
Is any of this science? Is CBT science. Or is all that is happening is that there’s a helpful person there when you need one. How would be know anyway? It could be all placebo effect, which means it works, because that’s also a change of mind.
Hypothesis: Freudianism works by giving the patient a terrible explanation for their problems, which they strongly reject, forcing them to figure out the actual explanation for their problems.
"I have problems concentrating at work"
"That's probably because you want to have sex with your mother"
"What? Ewwwww, no! It's probably just because I drink half a bottle of raspberry schnapps every morning. Maybe I'll stop doing that."
That’s a view of Freud that’s based on 90 years of stereotyping and simplification. “Freud was a guy who went around saying people want to have sex with their mothers because he hadn’t heard that theories should be based on evidence” should hold as much credence in your mind as “Rationalists are people who think we should all act like Spock all the time because they haven’t heard that emotions are actually important”
If you want to develop an actual hypothesis of ‘freudianism’ you’d have to actually, idk, read a book. But maybe you can’t. Maybe you need the act of understanding to be passed on to the Other so that you’re freed from either the joy or the obligation of knowing what you’re talking about.
I’ll be honest here. That’s not much of a defense of Freud as it is a an hominem attack on Melvin.
Asking someone to read a book isn’t much of an argument anyway - you could make that argument about the Bible, an astrology book, or the books about aliens building the pyramids. Also the assumption that people haven’t read Freud begs the question. I’ve read Freud which is why I’m unmoved by his arguments in general. There’s a few things he got right. Projection for instance.
On that subject, your last confused paragraph was about The Other; apparently anybody who dislikes Freud is a cad who expects somebody else (and not just anybody but the Other) to read the book. This is a charge of bigotry.
But isn’t Melvin and other people people who haven’t, or have read, Freud but don’t like him in fact your “Other”. Haven’t you ledgered them in your head in the bigots column without evidence. Are you not projecting?
I do sometimes wonder if Frasier gave a lot of people a string negative perception of psychiatry. Certainly seeing it as a kid caused me to take the field less seriously
I thought he gave decent advice for a radio shrink. Not that he needed a degree for that. It’s actually when he went into more Freudian analysis that it sounded phoney.
The whole joke is that Frasier holds himself up as self-important 'learned' doctor while being a dime store sell-out, radio shrink and Niles, who has stood true to his academic roots, holds him in contempt for this
Abt last paragraph, SSC has a post on that, "Scientific Freud".
"I was taught the following foundation myth of my field: in the beginning, psychiatry was a confused amalgam of Freud and Jung and Adler and anyone else who could afford an armchair to speculate in. People would say things like that neurosis was caused by wanting to have sex with your mother, or by secretly wanting a penis, or goodness only knows what else."
"Then someone had the bright idea that beliefs ought to be based on evidence! Study after study proved the psychoanalysts’ bizarre castles were built on air, and the Freudians were banished to the outer darkness. Their niche was filled by newer scientific psychotherapies with a robust evidence base, such as cognitive behavioral therapy and [mumble]. And thus was the empire forged."
"Now normally when I hear something this convenient, I might be tempted to make sure that there were actual studies this was based on. In this case, I dropped the ball."
"(...) largest study ever to compare Freudian and cognitive-behavioral therapies. It examined both psychodynamic therapy (a streamlined, shorter-term version of Freudian psychoanalysis) and cognitive behavioral therapy on 341 depressed patients. It found – using a statistic called noninferiority which I don’t entirely understand – that CBT was no better than psychoanalysis."
But both beat placebo. About that...
"Dodo Bird Verdict (...) psychotherapies work by having a charismatic, caring person listen to your problems and then do ritualistic psychotherapy-sounding things to you, but not by any of the exercises or theories of the specific therapy itself."
"if the Dodo Bird Verdict and the active placebo problem and so on are equally true of all psychotherapies and all psychotherapy studies, how come everyone become convinced that cognitive behavioral therapy passed the evidence test and psychoanalysis failed it?"
"And the answer is the CBT people did studies and the psychoanalysts didn’t."
"That’s it. It may be, it probably is, that any study would have come back positive. But only the cognitive behavioral people bothered to perform any. And by the time the situation was rectified and the psychoanalysts had (positive) studies of their own to hold up, “everyone knew” that CBT was evidence-based and psychoanalysis wasn’t."
I did say that talking cures work, for the reason that many people here agree on, just talking to someone who is intelligent will probably help you. So its possible that CBT and Freudian analysis work because of the talking, rather than than the deeper theory.
The "Dodo Bird Verdict" version I think I remember said there seems to be better and worse individual therapists, but not better and worse kinds of therapy. (Also, you can get a lot of the benefits of therapy by simply keeping a journal without actually paying anyone to listen.)
That's accurate. I work in the therapy biz (on the admin side) and it's well known that some therapists are just terrible, most are mediocre, and there are a few hot shots in any local market that everybody recommends because they get results. Typically these are the people who end up with a 6 month wait list for a new client. You get a lot of people who come in with the same story: "We tried therapy before, but the therapist wasn't good." Some people have enough insight and experience to be able to really cut to the heart of peoples problems and help them improve, regardless of model.
Frasier was more of a Freudian on Cheers. There was an episode where Woody reunites with an ex-girlfriend from his hometown, and the two of them begin to overeat tremendously, the way they did when they were previously dating. Frasier asks Sam what he thinks, and Sam gives what sounds like a reasonable pop-psychology answer - but Frasier says no, they're obviously sublimating their desire to have sex with each other into a desire for food, and tells the two of them to go get laid. (Which, thanks to TV logic, actually does solve their overeating problem!)
> But also: people vary really widely in their ability to do something sort of like hold a conversation with themselves - for example, some people totally lack an inner monologue. Nobody has ever checked if those people benefit from therapy more, and I don’t want to actively predict that they would. But I know that I talk things over with myself a lot. Does this help me stay emotionally stable? Not sure; seems plausible. If I didn’t have an inner monologue, maybe the only way I could get that same effect would be by talking them over with another person.
I would say that I don't have an inner monologue (I also have aphantasia), but am generally able to process my thoughts and stay emotionally healthy. I primarily rely on one-on-one conversations, mostly with my spouse, in order to hash out ideas. I also probably have some genetic predisposition to stay emotionally healthy -- at least that's what others have told me, and that seems like a good thing to believe so that I don't go around telling others, "why don't you just try to be more positive?"
I also have aphantasia and lack an inner monologue. I think the predisposition to stay emotionally healthy is the lack of inner monologue itself. With no rumination it is nearly impossible to be self critical or worried for more than a few minutes. Journaling and writing have been helpful to hash out ideas.
What is the process of writing like for someone who lacks an inner monologue? I'm assuming the words don't just appear on the page and must exist in your mind at least briefly? Is it just that when you're not actively trying to produce language, it doesn't ambiently exist in your mind as a sort of voice describing / directing your actions?
> Is it just that when you're not actively trying to produce language, it doesn't ambiently exist in your mind as a sort of voice describing / directing your actions?
Yes. Instead, I usually think of the specific ideas I want to write about, then translate them into words; usually I can do the latter more or less immediately, but occasionally it takes me a few seconds to think of the right word, or come up with the right phrasing, to represent the idea I want to express.
> I think the predisposition to stay emotionally healthy is the lack of inner monologue itself. With no rumination it is nearly impossible to be self critical or worried for more than a few minutes.
I think these are two different things. I don't have an internal monologue, but I have had recurring self-critical thoughts of the sort you describe.
I have no idea if I have an internal monologue. When I'm planning on writing something, or if I'm having a debate in my head, I have a clear inner voice. But I can't tell at all if I have an inner monologue at other times. Every time I try to observe my thinking everything goes quiet. This makes sense: it's a bit like trying to see what you look like with your eyes closed by looking in a mirror and closing your eyes. If I'm thinking about observing what I'm thinking all I'll find is observation with no content, because all I'm thinking about is "What am I thinking about?"
It seems like if I'm mulling something over in my head I have a monologue, but it feels a little forced? I have to make a mental effort to get in the headspace of "Lets figure this out." When I'm just going about my life, thinking, I can't tell if the voice is there. Because if I start thinking about whether I have a voice then the voice will be there.
Therapy is like having a friend that you can tell anything to and they can't get mad, leave you hanging, or tell anybody else. For people without close friends (which is a lot of people) they can work wonders.
I think that's true, but that also more complicated things are going on. I spent most of my life without close friends, but I didn't have (and don't think I would have benefited from) a therapist, because for me talking over my problems with other people doesn't make them better.
(cue gasps of disbelief and me pointing at the post I just wrote)
Speaking as someone who used to talk to myself a lot, and now talk with myself more often, I would say that an inner monologue is not nearly as useful as an inner dialogue.
And while I’m at it, watch with all the dumping on Freud?
Ego
Super ego
Id
The subconscious mind
Infantile sexuality, or the sexuality in very young people.
Freud never said that people wanted to have sex with their mother literally, (although clearly some do).
I think it’s much more reasonable to think of the extreme bonding of attachment that takes place as a small child, and the integration of physical sensations as information is obviously much greater in very young children. Those things are the predicate for one’s sexuality. I don’t think that’s very controversial.
I think Fraud was a very smart man and he came up with a lot of very useful concepts.
CBT is repackaged Buddhism. I happen to think they’re both useful.
On a sarcastic note I would say that there’s two classes of people who are completely comfortable with their mental health, people who are truly mentally healthy, and people who have talked themselves into believing that they’re mentally healthy.
For everyone else there is some form of therapy. I don’t think that one should underestimate the local priest historically in these situations.
It isn’t always possible to sort something out by yourself or with people you are invested in. Think of it as playing tennis with a better player. Is that a crazy thing to do if you want to get better at tennis?
I heard that the "wanting to have sex with your mother" thing was kind of an artifact of Victorian child rearing practices; among other things, Freud had a wet nurse, so the conditions for the Westermark Effect might never have occurred.
George C Scott and his wife starred in a film revolving around this conflict back in the 70s I think It has a reputation of being a bit of a stinker and I’ve never seen it but it did tackle this thing head-on.
The most beautiful film on the subject I think is murmurs of the heart by Claude Lelouch
> but I didn't have (and don't think I would have benefited from) a therapist, because for me talking over my problems with other people doesn't make them better.
I thought the same way, but at some point I decided to go to a therapist anyway. One of the main things my therapist tried to teach me is how to receive and request empathy in a way that is comforting to me. I had never learnt this in my family or elsewhere during childhood and at first I felt too vulnerable to really receive any comfort from any form of sharing.
But with some time I became more open and experienced enough to request the kinds of responses that would help me feel better. I think the important point is that "talking about problems" is not about solving the problem, but about feeling seen and heard by someone and receive empathy. I also think that the vulnerability that is being introduced on both sides in such an exchange is the foundation of feeling emotionally connected to other human beings.
Heh, so this is why you wrote it a bit defensively. I was the opposite, always having friends to talk to and who talked to me, and for me the post seems extremely non-controversial.
I have a lot of close friends, and that's been true for years. I feel comfortable talking to them pretty openly about my problems and emotions. They don't get mad at me for anything I say, or leave me hanging, or share my secrets. Regardless, therapy was helpful for me and made me more emotionally stable.
I had weekly time to speak to someone about my emotional reactions and figure out which reactions I wanted to work on (and how I would do that). So e.g., these days, if I get unreasonably panicky about feeling sick, and that panic is causing me a lot of suffering, I have all sorts of coping strategies that make me suffer less, and therapy helped me learn those coping strategies.
My friends helped with this too, but it's easier to debug my brain if I can have many selfishly one-sided conversations. And I'm more likely to attempt to follow mental health advice from a therapist than from an average friend, because I think the mental health advice from a therapist is more likely to actually work. (I hope I'm right about this, but not entirely sure.)
However, I think a good rationalist could've served the role of a therapist for me (without therapy training -- just CFAR training or equivalent). I think that could've been even better than working with a therapist.
Looking for somewhere to insert my two cents, but I've never felt this with a handful of therapists over the years - if anything, I always felt less able to have a conversation with them.
Not that I could have deep conversations with other people about feelings or mind-workings with other people until relatively recently either, but I'm kinda surprised by this characterization because I've never felt it to be true.
When a lot of people talk about therapy, they're talking about a very idealized version of how it should ideally work. Most therapies don't work as they ideally should. Anecdotally, I went through about 8 therapists as a child, and was somewhat surprised when I finally found one as an adult with whom therapy seemed to work.
I went to a counselor once for a problem I was somewhat embarrassed about. I talked to them for a while and they had some suggestions, which I filed away. But the problem never recurred, and I think part of the reason was that I really didn't want to sit in front of this high status person and explain how I'd failed to apply the really basic method they'd taught me.
I wonder how many people get a similar benefit from therapy - better not relapse, lest I have to explain it to this expensive professional?
Yes - part of what I got from paying a therapist was definitely 'accountability' - feeling an obligation to have done my homework / to actually try things out when asked to do so in session rather than just going 'hmm, that seems like an interesting idea' and then not actually implementing it.
Thirding this. Got very basic advice my friends had told me before, but hearing it for an hour every week is a bit different than once every few months, the accountability was much higher
I was totally shocked when I first learned about that. How can it possibly work? If they are waiting in line at the grocery store what do they think about?
How can you have thoughts without words? Rather than think, “I need to get gas and stop at CVS.” You see the low gas gauge and the item you need at CVS in your mind?
That's what I would guess. The same way that a lot of speed-readers recommend not thinking/vocalizing the words you read and thinking in the concepts they represent instead.
Do people really vocalize/think the words out loud when they read? I do not do that, and assumed other people didn't either. It just sort of washes over me and I understand it without thinking about it.
Yeah. I do it, both when reading and writing, there's a specific "voice" I hear. I've taken a speedreading class and have tried forcing myself to make the words "wash over me"; I can kind of do it, but it's effortful and feels like I'm missing things.
At least for me, if I pay close enough attention to my inner monologue I realize that it's actually following just a bit behind my actual line of thought. I suspect that for everyone thinking actually has nothing to do at all with monologuing, and you hear a little voice for other reasons. What reasons those would be I could only guess, but considering I've often struggled to put an insight into words while being perfectly able to think about it, it must be true.
I sometimes finish a thought before the monologue expresses it, and stop thinking the now-redundant monologue. But then get a sense of incompleteness until I've gone back and thought the end of the monologue as well. (It's a similar incompleteness-sense to that inspired by a Ctrl-C without a Ctrl-V, or an unclosed parenthesis
YES! Every once in a while I feel the urge to try and ditch the extra work of the monologue, and sure enough that sense of incompleteness screws it up every time. I feel like the most likely explanation is that it takes conscious effort to notice the overhang, and that attention interrupts the silent stream of thought as it tries to stop the loud one.
I often have a voice in my head constantly thinking about how to describe what is happening in my journal later. I suspect this is a consequence of journaling.
Concepts activate in a kinda felt-sense fashion, sometimes these compress into a linguistic-like 'sentence' that's rememberable. So I might be thinking about what I need to do (non-linguistic, just a feeling), scanning through some association-triggers - for home? for work? food? (still nonverbal), remember something, and have a verbal restatement of what I remembered which brings it more fully to attention: 'Oh, I need to buy toothpaste', or more likely just 'toothpaste' as a single word
I'm still trying to get over the fact that when someone says "picture an apple" most people just have a picture in their brains of an apple. For me it got translated to "you know what an apple is, so think about that." Would have never occurred to me that thoughts came with pictures.
I can sorta picture things if it’s relevant to a problem. Like trying to do geometry in my head I usually summon a little picture. But if you ask me to think about an apple it’s just a rough assembly of concepts.
I had this sort of thing with depth perception. I could never figure out exactly what people meant when they said "depth perception" since I always judged stuff by a variety of visual clues. And then I got sunglasses that let me see depth, realized I hated it, and got the prescription removed from my sunglasses.
I have an intermittent inner 'monologue' (after considerable meditation, I used to have a much more active one, and it's rarely been a singular voice / train of thought).
What am I thinking about in line at the store when my monologue is quiet? Possibly a detailed impression of a sense impression I'm taking in, possibly I get some internal music playing, possibly a memory of a sense impression (or a mixed / made up scenario or dream), and possibly just literally nothing - I'm not sure if those times I'm really thinking of nothing or just not bothering to form memories, it's somewhat hard to tell!
I was surprised when I learned that for many people, "inner monologue" was not a metaphor for thought, but it meant that people literally have words going through their mind most of the day.
I mean, compared to pure ideas, words seemed so slow, so imprecise, so low-bandwidth. And so distracting--if your head is talking to you, how can you ever focus on anything? I thought it was a miracle such people could get anything done!
For me at least, thought words are significantly faster than spoken words. That doesn't really help with the imprecision and low bandwidth, but those are obstacles you're going to have to overcome when it comes time to communicate your ideas anyway, so I don't consider that much of an issue.
If I need to apply external knowledge outside my brain, such as in writing or math or some such, I translate them into words or diagrams. If I need to apply it inside my brain, there is no translation needed. They are already in a form that can be altered by learning, even if the learning itself consists of word-transmitted ideas.
Pure ideas are indeed extremely fast but putting things into words has a way of structuring and organizing thoughts that would otherwise be aimless and ephemeral. I am able to think without words if I try really hard, and it lets me think *fast*, but it doesn't let me think *well*.
Around 18, I began to think in words sometimes, and I probably do so now a majority of the time. I miss thinking without them; it felt faster, more pure, and I felt more creative and less constrained by the ideas available to language. However, I am a more precise and consistent thinker now than I was before, which supports the "thinking well" angle. Though this is after aging a decade, getting a physics degree and studying rationality, and I'd guess that some or all of that matters as much as or more than thinking in words.
The one thing I definitely credit to the change is that now I am able to converse much more fluidly, and I never lose words just on the tip of my tongue. Before, I would have to translate my ideas into words just to speak them. That was a fast process, but it was slower than just having it all come out like it does now. I often felt left behind by a conversation that had moved on before I could assemble what I wanted to say about a topic.
As I read your comment I was simultaneously actually saying the words "two, four, six, eight, ten, eleven" in my head as I counted knitting stitches. I do not think I could count absent words. Even trying to glance around the room without thinking "words" - I looked at the lamp, and my brain threw up the word "lamp".
Separate question: do people who are good at chess see a chessboard in their minds? I am terrible at chess, so for me, it might as well be trying to imagine what's going on in the brain of a different species.
I don’t play chess much, but I can visualize a chessboard in my mind. If I try to play a both sides of a mental game of chess, it’s hard to keep the entire board state consistently loaded and evolving according to proper rules (the thing that tends to get me first is accidentally moving bishops not-quite diagonally), but I think with more practice it would be totally possible for me to run a functional “mental chess-engine”.
In fact, given that various chess players have played blind chess successfully, they must be maintaining a mental map of the board.
I see a chessboard in my mind, and I visualize a chessboard in my mind even if I'm also looking at a physical chessboard. Part of that is thinking ahead, but part of that is that when I visualize the board, I visualize the relationship between the pieces.
When a diagonal line of pawns all protect each other, I imagine them being linked together into a chain. A rook can be "holding onto" a piece it's protecting across the board, a king is projecting a forcefield that stops the other kind from getting close... now that I think about it, not all of these have real visualizations attached, but they definitely all have concrete locations on my mental chessboard.
Maybe it's a bit like feeling the location of the pieces and their movement potential the way you feel the positions of your limbs. Wanting my knight to move one square over feels like wanting to touch my elbow with my hand (on the same arm).
I have nearly always counted in words, and often if I'm thinking about a particular type of thing, like a lamp, the word is part of how I think about it. But though I'd think the word "lamp" when contemplating a lamp, it would never appear in a grammatical way as part of any larger thought, like, "I should turn the lamp on".
One thing I am sure of, pace others in this thread, is that I cannot control my thoughts whether momentarily or from day to day. Or, I believe I can't and maybe there is ultimately some hubris there. Controlling my behavior is the imperfect best I can do.
I used to play tournament chess, and was rated expert at one point. Long games are all about inner monologue (blitz is more System 1). "Ok, I push to e5, kick his Knight back, then I've got Ng5 and Qh5 setting up an attack, but is that gonna work? He's got Nf8 seems to hold everything" like this for 4 hours.
Fun fact though! I received an ADHD diagnosis late in life and use chess to train executive function. There are some studies that link attention issues and poor non-verbal working memory (essentially the ability to hold images in your mind). A single, not very good study in children found that a daily chess game improves non-verbal working memory and ADHD symptoms.
That's cool if it's helping. Chess does train focus and pattern recognition skills. Lichess.org has some good tools like puzzle streams, good online club.
I have never been very good at mental picturing. I don't think I have aphantasia; I can summon something that feels like a mental picture, and it takes work and focus. But the pictures are so faint that I'm not certain whether I'm actually "seeing" them, the way people describe, or just sort of feeling the residue of what it would be like to actually see the thing.
I've always been very good at keeping track of where things are in spatial relationships to each other though! Mental rotation is easy, and so is imagining geometry, or objects arranged in some specific configuration. When I imagine a doorway, I kind of intuit the disembodied shape of it, in a way that feels kinda-sorta visual like I can "see" the rectangle with those dimensions, but it doesn't appear in my mind as an image I can actually see at all, much less an image of a particular doorway with details.
I'm not good at chess (maybe 1300), but I "see" these ghostly shapes when I play. Every piece has its position, and there's a sort of line of force emanating from it to every the space it can move to. I actually don't know why anybody would care about being able to see pictures while they play chess, or how it could help at all. Don't you just know where the pieces are, and where they can move (and where they can move from there, etc.), and that's enough? Actually having a picture of a chessboard to go along with it just seems redundant.
Probably having the details of how the knight looks is redundant, but there is definitely an advantage to being able to "picture" where the pieces are after a move. Humans are very limited in how many explicit verbal ideas they can hold in their working memory at once, but much less limited in non-verbal memory. This is why magicians who do memory tricks (like memorizing a whole deck of cards) will talk about a "memory palace." If you try to just keep a running list in your head of each card, most people will max out around 7, though some folks can do more. But if you have strong non-verbal memory, you can create a visually interesting mental space that contains each of the cards, and then just sort of tour it to get the order. That's an extreme use of non-verbal memory, but there's a reason they use that technique.
It seems likely that non-verbal memory takes a lot of different forms. For instance, I am almost entirely aphantasiac visually, but I can easily conjure sounds and smells. So it may not be necessary that you literally be able to form pictures to get the advantage of this expanded holding capacity while playing chess.
But it is absolutely true that if you have bad non-verbal memory (as I do), trying to imagine the board state after 2-3 promising moves 2-3 moves deep quickly becomes like trying to hold 20-30 bowling balls. You have to not only know where the piece you're moving will end up, but also what new files or diagonals are opening, etc.
Some preliminary studies suggest that regular chess practice may improve non-verbal working memory, though often promising work in improving that particular skill turns out to be bunk.
At risk of being metronomic, do check out Blake Ross's essay on this -- he's a bright guy (Facebook director of product & Firefox cofounder, wrote the script for Silicon Valley S3E1 etc) who had nevertheless felt stupid a lot growing up because questions like "What did you do today?" completely stumped him; discovering that he was aphantasic (and that most people are not) clarified all this:
I lack internal monologue/dialog (seemingly, some of my sane-acting friends, have multiple voices in their head). I can talk to myself in my head, but it's forced. I use it basically only when thinking about social interactions - I'm autistic and somehow it's easiest way to understand some more complicated social situations.
My thoughts aren't easy to describe. When I'm thinking about math, there are unfolding images of equations. When I'm thinking about my job (software engineering), I see some kind of UML diagrams, and sometimes graphs. When I think about biology, it's graph of concepts. When I'm thinking about engineering or DIY, I just see schemas of objects.
Sometimes I just get answers - I think of question and after few seconds of nothing I get answer, but I don't know how I got it. Usually I can reverse-engineer that answer.
Impaired insight, common among autistic people, can play part in this.
I go back and forth between having an inner monologue and not. I do most of my important thinking nonverbally. I don't have any inner monologue when I'm taking a test of math or geometry or chemistry. I only need the inner monologue for doing verbal things.
I find that despite having a constant inner monologue, all my thinking is done non-verbally. The voice in my head is just constantly *composing* my thoughts into an explanation. My guess is that this is the case for everyone, to lesser and greater degrees of noticeability.
Yeah that squares with my thinking (pun intended). I'm definitely not hearing my inner monologue while speaking, and usually I don't while reading or focusing either. But obviously you still have to think while talking! So the thinking and the auditory hallucination are two different things. I wonder how many other people are in the same in-between region you and I seem to be in
As a former mental health counselor and someone who has been in therapy myself, I see the value of a therapist. I also see value in friendships and meetup groups. The cost makes you sure you will get value from therapy. IE: "Why would you pay for something useless?" "Cognitive Dissonance" is when you do something, you want to believe it makes sense, so you change your thoughts to explain your actions. Some people know themselves better than others. Some realize the value in knowing themselves and want help doing it better. When the outside world tells you to be one way but internally you feel the opposite, I think therapy works. After all, the therapist is paid to be honest with you and so many other people selfishly tell you what you want to hear or what is best for them.
I think what it comes down to for many people is personality style and where on the scale of functional to dysfunctional they fall on for each style. If your traits in these areas (i.e. obsessive-compulsive, paranoid, hysterical, depressive, impulsive, etc.) do not reach the level of neurosis, basic self-help and behavioral activation will suffice. Once you reach the neurotic level where your cognitions or actions are negatively affecting your life in some way, it is probably more efficient for you to talk it out with a therapist, pastor, priest, rabbi, etc. Once psychosis comes into play, you will most likely need some kind of psychopharmacological intervention.
I imagine most people in the EA community would fall into the obsessive-compulsive style, which is selected for in high-pressure environments.
It feels like there is an additional major ingredient that wasn't mentioned here - the healthy relationship. It never ceases to shock me how many people lack basically consistent, supportive, and loving relationships, and how beneficial it can be to simply sit with a caring individual on a regular basis, remunerative or not. It's soothing to the nervous system; it's reassuring; it's (for many) a necessity that's otherwise unmet.
I've noticed recently that I've really enjoyed novels where all the major characters are basically friendly, and the protagonists don't have to constantly tolerate bullies or corruption or entitled brats or the other persistent assholes that drive the tension in so many other stories. I find it soothing to read a story where the point-of-view character knows that they're surrounded by reliably cooperative people.
Makes sense to me - a similar desire for positive interactions with trustworthy, caring individuals. Everyone needs social safety and a feeling of being basically liked. Most of us didn't get it from our parents, of course. Harvard professor/Mahamudra master Dan Brown developed a visualization protocol for addressing attachment disruption and two of the five pillars are a sense of safety security, and a feeling of being genuinely liked: https://www.youtube.com/watch?v=z2au4jtL0O4&t=369s (10 mins, worth it)
Here's a couple stories that gave me this feeling:
One is "A Succession of Bad Days" and "Safely You Deliver" by Graydon Saunders (books #2 and #3 of the Commonweal series). A small group of people don't realize until adulthood that they have strong magical talents and need to be trained or their magic will kill them. All the students become friends, and all the teachers and civil servants they encounter are basically good people trying to do their jobs well. (I don't know WHY it's called "A Succession of Bad Days"; they pretty much succeed at everything they do.) These are available on the Google Play store.
Another is "Beware of Chicken" by Casualfarmer. A guy from our world gets portaled into a Chinese fantasy world where people cultivate qi and practice fantasy martial arts; he immediately decides to run away and become a farmer, whereupon he accidentally uplifts his farm animals by infusing them with qi. This is currently being published as a web serial on Royal Road, but supposedly the first chunk of it is soon to be released as an ebook. (If you prefer reading ebooks, the browser plugin WebToEpub can also suck the whole story off Royal Road for you.)
I think This Used to be About Dungeons by Alexander Wales qualifies. It's a very chill story told from the point of view of five characters who originally get together to dungeon delve in a fairly utopic fantasy-ish world, but it ends up being about their lives more than the dungeons (as the title suggests). It is also a web serial being published on Royal Road.
I remember enjoying Stargate SG1 (the early seasons in particular) for exactly this reason. Intelligent ensemble cast, trying to do a good job under difficult circumstances that were (almost never) caused by interpersonal issues. Basically, professionals being professional! Person of Interest ticked a similar box for me despite being extremely different in tone. It's nice to see highly competent people who are also trying to be unselfishly good.
I have some good relationships but sometimes they are giving me problems because those people have problems and I cannot merely tell them to stop having their problems.
Maybe there is an easy answer. If I can pay $150 to get the easy answer, it is money well-spent.
Don't therapists also practice what I would call "strategic listening"? By that I mean they're trying to pick up details that would indicate a field-tested strategy for dealing with the person's problems? Ordinary friends wouldn't really have the same type of experience in that regard.
Therapy is about having a healthy relationship with a trusted person. That's often thought to be the reason why most mainstream schools of therapy are about equally effective—therapists will say they have different theories and techniques, but de facto what they DO in therapy is generally similar. And then, one theory for why therapy can work is that the patient develops a mental model of a trusted, knowledgeable person they can talk to or whose perspective shows up in their imagination when they have decisions to make.
Obviously all of this is super-idealized "how it should be" rather than how it is.
I had two sessions with a therapist about a year ago when I was terribly, terribly depressed and under-confident.
In the first, I explained to him that I wanted to quit my miserable law job that I was terrible at and do software design, which I obviously have a talent for. I explained that I had a lot of confidence in my ability to career switch, that I thought the transition would be successful, that I'd given it a lot of thought, but that I felt stuck in the law job. He responded (with the tact and grace that therapists have to use) "Uh, okay, so...do that?" And then I did, and it worked.
I had a second session a couple months later, having improved significantly and successfully made my career switch and he said (again, with much more tact than given here) "So...what else do you need then? Why are we still having sessions?"
On reflection, the first session was him giving me permission to get to a place where I didn't need permission to do things that were good ideas, and the second session was him saying "uh, dude, now that you know your own judgment is fine you don't need my permission to do things that are good ideas."
That seems very very silly in retrospect. I don't think he was particularly skilled at drawing out emotions or deep healing or whatever. He literally responded the way any sane person would to a person saying "Hi I'm unhappy and this would make me happy. Should I do this?"
But from inside a mind that was completely enveloped in self-doubt and depression, it would have been absolutely impossible for me to figure out that the best way to stop doing stuff that made me miserable was to just not do stuff that made me miserable anymore. So good job random dude. And kudos for not milking me for weekly therapy sessions for a year and a half. That was the secret sauce.
I've had anxiety/depression for as long as I can remember, and therapy didn't do anything for me. The therapists were very nice and I went to plenty of sessions, but I don't remember any effects at all. Maybe because they didn't have anything new to tell me that I hadn't already thought of?
Meanwhile, meditation has been working extremely well for me. I feel like the anxiety dials itself down from 5/10 to 2/10, and my psychosomatic pain goes from 3/10 to 1/10. But then it comes right back the moment life interrupts my ability to meditate daily without being sleepy (another victim of Daylight Savings time).
And some people are *too* good at having conversations with themselves, they ruminate and reinforce unhelpful and inaccurate views about the world and other people. Bouncing the thoughts off someone else gives a chance to interrupt the death spiral.
It seems true to me that therapists are making up for something lacking in people's conversations with themselves, but you'd have to be a rationalist saint to not be lacking in any of these ways. People aren't instinctively introspective, and lots of obvious things aren't obvious until someone points them out to you explicitly. Remember your story about the person who had no sense of smell, and explained the whole thing to themselves as a metaphor, instead of realising everyone was experiencing something they weren't? That's the human brain doing what it does best: explaining instead of noticing.
There's also the fact that big risks are both irrational and a part of life: Because you evaluate new ideas in a way that you don't evaluate the status quo, it is very very easy for a person trying to make a rational decision to argue that literally everything should remain the way it is forever. I certainly have an overactive inner monologue and can successfully argue myself out of doing anything interesting ever.
Was going to say something similar, I went through a period of depressive self-loathing and my experience with therapy was less about finding someone to talk with and more about finding someone who could tell me that actually, no, I wasn't objectively a terrible garbage person (and who could understand the monologue playing on repeat inside my head well enough to point it out to me in a way that allowed me to question it).
True, a lot of people have pathological inner monologues. I don't think it is a matter of being "too good" at it but more of their monologues being unhelpful instead of clarifying.
I'm surprised that this discussion doesn't include interpersonal dynamics as a success dimension.
I have been to a few phycologists in my day, and honestly none of them were all that helpful to me in the aggregate.
However, there were a couple (literally two) times where a therapist would toss out a key phrase or an observation that seemed to instantly unlock a door in my mind and give me a new way to think about things.
The chances of me striking gold again would appear to be rare, but I'd be willing to go digging for gold if I knew how to identify the right person to invest my time with.
Ultimately, it seems to me that finding just the right person to discuss your distinctive set of circumstances with is perhaps the most important variable in ascertaining therapy efficacy.
It might also just be helpful to hear perhaps obvious truths said by someone you've imbued (rightly or wrongly) with authority to say something. The power of "have you tried this" isn't just high if the "this" is some deep insight.
I also think for many folks I know they a) either find this uncomfortable to do by themselves, b) don't have peer groups they'd trust to say it to incl spouses, and c) this becomes a ritual and rituals are comforting and helpful even if it's a placebo.
I'd wonder which of this,if any, Scott finds in his practice too.
Anecdotally, one of my best friends finds therapy completely ineffective, but she is also constantly thinking about her own problems. Versus me who has found therapy immensely helpful, as someone who finds self-analysis difficult to deal with
Predictive processing seems to suggest that most of us are living inside of something like 'cartoons.' _Especially_ in the area of "what happens inside other people's heads", because there's so little feedback from reality there. So maybe this is why some people's internal experiences seem so weird and out there to others?
I've been seeing the job of a therapist (or the coach I see), as something like 'increase the resolution of my cartoon so that it matches reality a little better. I suspect that trapped priors play a big role here. For example, I see an attitude coach, and our conversations are probably _extremely compressible_. "You don't need to expect yourself to be perfect" is the kind of thing that i've repeated to myself over and over and over and over and over, and i'm sure glad there's somebody i can pay who consistently notices when i'm acting in a way that suggests i expect perfection from myself.
A bit off topic, but this morning I read for the second time "Good Old Neon" by David Foster Wallace. One of the themes is the relationship between the narrator and his therapist. You feel sorry for the therapist in a "Good Will Hunting" therapy scenes way( before Will gets to Robin Williams). It's a brilliant and powerful piece of writing that should not be read if one is in a depressive state.
I am pretty sure most people would benefit from therapy in a wider sense, i.e. structured self reflection with the help of a trained person. Unfortunately I learned that only after my divorce and after I hit many walls with my rationality.
However, I am also convinced that talk-focused therapy is not the best way for many rational people. Body oriented therapy forms, including and especially intense breathworks seem to work better with mind-focused people. And - yes - psychedelics in the right setting
Because I agree with the statement that "everyone is defective in some sort of basic human functioning" even though I wouldn't use the word defective. But everyone has blind spots, and it helps to know these and make them visible
This is a pessimistic thing to believe. Do you think everyone is defective in some biological (i.e. somatic) way too? If not, what makes the mind especially defective?
It's just my experience with people, and I said that I wouldn't use the word defective. Think of therapy like the things you do to keep your body healthy - from dental checkups to doctor visits - totally normal to do from time to time
I seem to remember Scott mentioning previously that CBT was originally very effective and now is shown to be less effective, and one theory for that is that everyone gets small doses of CBT from society and their relationships and they have already reaped a portion of the benefit, so there is less to gain when they are exposed to it in a clinical setting.
So we could easily be in a situation where most people could benefit greatly from therapy 40 years ago and now a smaller subset of them would receive a similar level of benefit today because they are getting their therapy from the community.
I somewhat agree with your statement but would put it differently: Today, the spectrum of therapeutic settings is much bigger than it was 40 years ago. You have therapeutic breathworks classes,retreats of various kinds, and much more. So going to a talk therapy fortunately is no longer the only options. Chemicals that help some people, from CBD to 5HTP to psychedelics add to this spectrum
Imagine a new modality that 100% cures about 15% of the people who try it. Imagine its so brand new only a few hundred therapists practice it. Now, imagine that a potential patient can hear it described and determine with a high degree of accuracy if it will work for them based on an initial gut reaction.
Solve, as they say, for the equilibrium.
You get an initial rapid uptake in adoption, where all those self-identified high-responders go after it and find a great response. And wozers, look how well it works for everyone. Then, low-responders get convinced to give it a try even thought their gut (accuratly) says its stupid. You'd see this exact phenomenon you're describing.
I don't know the numbers, but this is exactly the process by which most successful inteventions work in both talk therapy and health-and-wellness. People who hear about CBT and think it sounds good have great results if they stick to it. People who hear about couch-to-5k and think it sounds good have great results if they stick to it. I tried couch-to-5k once even though I hate running, and it sucked and I gave up. My physical therapist said "You can live the rest of your life without running a single step, if you want" and I said "huh, he's right" and now I just do strongman shit in my garage and it works great.
I would argue that therapy is optimized to provide the perception of value. In much the same way that being aware of a systematic bias doesn't make you immune to it, people come out of therapy with some profound realization about themselves and then don't do anything differently.
I'm not necessarily saying therapy isn't effective, but self report is basically useless here. There are no counterfactuals, and outcomes are poorly measured.
Outcomes are poorly measured for sure. But also, the point of therapy most often is to reduce a person's suffering, which is a subjective experience entirely distinct from one's life circumstances. Sometimes doing something differently is essential to reducing suffering and very often it's not. See also Buddhism.
I was introduced to the idea of therapy more as a check on one's inner monologue, rather than as a substitute for its absence. In my experience, therapy was a helpful way to escape the destructive framing sometimes provided through introspection alone. In that respect, it doesn't feel too different from exercising principles of rationality, like rooting out cognitive biases, clearly stating assumptions, reflecting charitably, and showing your work.
The first time that a differentiation of different types of therapy made sense to me was in the book summary by Kaj Sotala of "Unlocking the Emotional Brain". There was a graphic included (at least in the print version) that described behavior therapy and emotion focused therapy as targeting emotional responses, psychotherapy targeting episodic memory, and Cognitive behavior therapy as targeting semantic structures.
I don't know how well this description meshes with either practitioners or patients. I also don't know anything about "supportive therapy". Is that the same as what I've heard referred to as "talk therapy" or is there a nuance I'm missing?
I'm wading into this discussion as a pretty blank slate without many preconceptions or background knowledge, so please forgive me if I'm framing this poorly.
(Edited to make it less ambiguous that the book summary was by Kaj Sotala instead of the book itself).
Seconding curiosity about this. In particular - how would we know? How could we rule out a difference in language used to describe internal experience, vs. a difference in the experiences themselves? I trust that some people have done their homework and it's actually true. But I'd love to see the receipts.
Basically it compares people's self-perception (using the "DES method") of inner speech against the speech parts of their brain activating in the MRI scanner. And the two were reliably linked.
Also: Worth knowing on this topic that there are two kinds of inner voices - the one in the study above reflects the kind of most people's inner voices which is "articulatory". The inner voice feels a bit like you about to speak, but you're not speaking.
People also have "auditory" inner voices, which are imagining audio of voices. So that is imagining you are hearing something. That voice can vary richly in tone and accent if somebody has a good audio imagination. It could sound like your own voice, or other people's voices, and this gets used in an extremely varied number of ways.
Ah thinking back, I guess you're asking for a paper which has taken someone who says they don't have an inner voice, and their speech centre hasn't fired over a decent length period. So yes, which studies are good and cover that well is your real question...
I mean it’s definitely clear to people who have interval monologues that they have them, right? Or that we can visualise things, which people with aphanasia cannot. There are apparently tests, but self reporting would be reasonably accurate regardless.
I believe an "inner monologue" is just the verbalization of things that you've heard, yet not had the chance to say out loud. See also: The chants of children in the schoolyard.
It’s not what we have heard, except for music but the ear worm effect seems like a different part of the brain. It’s conversations with ourselves or others.
Funny enough the idea of meditation is to quieten the inner voice, so those of you without it may be zen already.
I have a feeling that "lacking an inner monologue" is a self-serving way of accusing people who've reached zen state with having some sort of non-decipherable disability. But hey, you can't blame 'em, those zen monks speak in koans.
I honestly don’t know if I have an inner monologue or not. Does that mean I probably don’t have one? As in, for people with strong (loud?) inner monologues, is the fact of their existence impossible to ignore?
They vary hugely in strength and personality, and what they talk about and when they speak, between people. Also they can be articulatory (like you're about to speak) or auditory (imagined audio).
I think it is probably possible to have a weak one and not realise. I have a very weak visual imagination, and didn't count the weak thought forms (some spatial relationships, some colours) as "visual" when other people were describing seeing whole scenes like a movie when reading a book.
Similarly, it is possible you have some kind of inner monologue but it is weak.
Most people though seem to have an inner monologue, and if you ask them know what it is saying, and could somewhat recite it.
Thinking about my own, when and how I have one and what it is like does vary hugely over time. It is also hard to talk about, as the act of talking uses the same part of the brain as the monologue, so stops it.
If all the content of your thoughts were transcribed to paper chronologically, would it result in an easily interpretable string of natural language? If yes, then you have an inner monologue.
Isn't "easily interpretable" relative? I have an inner-monologue, and it feels understandable to me, but I don't voice them to the general public because I've had bad experiences in the past with doing stuff like that. Maybe an inner-monologue is a function of how readily your ideas are accepted by society.
Whether the ideas expressed in your inner monologue are understandable is irrelevant to whether you *have* an inner monologue. I specify that because some people might think in words, but not in sentences.
To even start defining the "inner monologue" as something that is either words OR sentences completely disregards those people who speak and/or think in languages that don't function with the same grammatical framework that English does. Your understanding of what is or isn't *understandable* already prevents you (and pretty much everyone else trying to tackle this problem) from understanding the nature of the inner monologue.
What? The question was "how do I know if I have an inner monologue or not?" and the answer lies in how much of your thoughts are expressed in language. What does the grammatical framework have to do with that? Language is used to communicate between people, so *by definition* it has to be understandable.
I do not have one. I "talk in my head" almost only when I am rehearsing a conservation that I am planning to have. I sometimes think that I should work on having a much more frequent inner monologue, because I have the impression that lacking one is making sometimes ignoring obvious things, but at the same time I feel that having an internal monologue would slows down my thoughts...
When you reherase the conversation, do you talk in your head with both sides of the conversation, so the other person as well?
And do you hear different accents and tones?
My guess is you have an audio imagination, and use that for rehearsing a conversation. Which is a kind of inner monologue!
Quite different from the more common articulatory one (like you're about to speak but aren't speaking) which lots of people partially narate / think through their lives with.
"(like you're about to speak but aren't speaking) which lots of people partially narate / think through their lives with."
That is what I am doing when rehearsing a conversation but I am almost never doing it (at least consciously...) otherwise. For example I almost never narate my plans for the day, or my opinion of someone, etc. My thoughts are usually a jumble of emotions, concepts, music, etc.. but very few words or sentences.
I wonder, do the different "thoughts" and or "voices" and or "voiced thoughts" have different accents, or ways of speaking? You may be experiencing what Freud (or some other equally german psychologist) calls introjection, when you internalize someone else's voice that you've heard.
Hear also: The Voices of Ancestral Spirits (or your parents, or other such authority figures)
To me the distinctive thing about therapists is that they are:
1) Pretty intelligent people
2) Who are paid to help you
3) But who are willing to offend you in ways friends/family might not be.
As a consequence, you can talk to them about stuff that would otherwise be taboo for you. If you're full of shit, they'll tell you. If not, that gives you permission to explore new sets of ideas. I think people generally underestimate how much of what's in their heads are the same thoughts that have been swirling around, unexpressed, for years.
People can be resistant to expressing those thoughts, which is why it can take a few sessions to make a "breakthrough".
Those breakthroughs are what's behind those people (including me) who have gotten extremely high ROI out of just a few sessions.
The rest I think is just life coaching by another name.
It sounds reasonable that many people will benefit from having someone to just sit quietly and listen to them talk about their problems. The act of explaining your problems helps you think about them.
But if the main skill is sitting quietly, why do therapists make a couple of hundred bucks an hour? Where are the minimum-wage therapists? An Uber driver can sit quietly and listen to people talk about rubbish for hours, if you take away the fuel costs he'd be a lot cheaper.
Heck, even if you insist on credentialism there's a helluva lot of psychology graduates who can't get a job in their field; give them a two-hour crash course in "sit quietly and listen" and let them charge thirty bucks an hour, they'll be happy.
Because it is important for them to have enough prestige for you to trust them. Lower-wage versions include priests, community leaders, grandma, etc. with varying levels of skill and/or being paid by other means.
I think some degree of safety is guaranteed (or at least can be litigated over). Imagine you were telling your uber driver about an embarrassing story, and then he laughed at the end, making the trauma worse. You take that risk by telling it to your uber driver. With your therapist, you assumedly aren’t
My experience with psychologists is that the majority are there to listen to and soothe the anxieties of well off people without deep problems. Or to be used as internal weapons in behind doors struggles.
Of course, there are many that are not. Some deal with people with deep trauma or real mental issues. But your average therapist in an office in suburbia is mostly there to get paid by a husband to make his vaguely disatisfied wife feel less vaguely disatisfied. (I've also seen therapists who are effectively used like weapons. One therapist in Mass. had a good reputation as always siding with the woman and so was popular with a certain type of wife or daughter.)
The issue is these two get mixed up. Someone spends their entire career convincing wives that yes, gosh darn it, it IS meaningful that your husband didn't put the toilet seat down. Or husbands that yes, they're not Fabio but their wife still loves them. And then someone walks in with PTSD or deep complex trauma and they think they can handle it. But they can't and they just run out the clock on sessions accomplishing nothing.
There are no doubt therapists who could help these hard cases. But there's no meaningful way (from my point of view) of determining which is which.
Didn't you just point it out yourself? Look at their clientele. If Dr. Schmo works at the VA and 85% of his clients are Iraq and Afghanistan vets, he will at the least certainly not wig out when confronted with a serious PTSD issue. Likewise if Dr. Foo has a tony office in Beverly Hills with a load of cat posters on his wall and the waiting room is filled with middle-aged women with $40,000 earrings and Botox everywhere, you might want to reconsider whether this is the right person to deal with the nightmares you've been having about the rape.
Ah OK, I misunderstood. I was interpreting you as saying there are no ways, but what you are saying is that what ways there are are not practical. Do therapists really false advertise like this? Seems ultimately self-defeating. I mean, if I tell someone I can fix their lawn mower and I actually have zero relevant experience, I'm setting myself up for an embarassing failure.
Yep. I'm not saying it's literally impossible. But it's not done or at least I've never encountered it. I expect set up costs for a client are pretty cheap. It's just a booking. If it's $100 a session and I come in three times they've made $300. Plus there's a list of excuses as long as your arm about why it's not working or you need a few more sessions. I've had some very bad experiences. Even with people who supposedly specialize in deep traumas.
Bummer. You'd think the guild would do a better job of self-policing, in the interests of the image of the better/senior members, but oh well. I'm pretty confident *among themselves* they are pretty clear about who's a rockstar and who's a charlatan, but it doesn't seem to go outside the lodge walls, more's the pity.
Come, they needn't violate HIPAA to characterize their clientele generally. They could even literally give you a redacted client list -- this many cases of ADHD, this many cases of marital discord. And I guess I would have naively expected them to do so pretty openly, in their own self-interest of achieving good success rates. But maybe they don't! I suppose emotional advice could be a field as rife with hucksterism as financial advice, more's the pity.
HIPAA is pretty strict liability. They can anonymize the data and pass it off. But if someone figures out how to trace any of it back to a specific person they're liable. I've never seen it offered and when I ask things like how many cases of X or if they have any Y as clients they've usually given vague answers. "How many depressives have you dealt with?" "Well, I can't tell you exactly, but many."
That's just fucking lazy. Good thing I'm not a member of the profession, so I don't have to be embarassed. I wonder if it's some kind of weird trust issue, like they're thinking "If you don't come in with some kind of quasi-religious faith that I can help, I won't be able to help?" Or maybe it's a hazing ritual, like if I can get you to accept this thing on pure faith, then it's a good sign I can get you to do all kinds of later things (during therapy) on faith, without having to argue out every point (which would be tedious and counter-productive I agree).
Either way, it wouldn't suit me at all. I would definitely be in the mindset like I'm *hiring* you to help me, like I'd hire a plumber to fix my drains, and neither of us should be embarassed if I ask for some proof during the hiring process that you have done this kind of work before with success, that's just good business sense.
I guess I would have trouble finding a therapist :)
If I had to guess, I think it's simply due to the fact that "guys want to be cool by not wearing jackets when it's cold."
I think the rationality community is very apprehensive about attributing common problems (for people like ourselves) to our relationships that we've had with broader hierarchical structures in society.
For example, a guy would (if he had been raised on that island that that king thought about once) if he felt cold, put on a jacket (or at least, fashion himself a jacket out of palm fronds or something I've never been on that island).
But seeing as how we don't live on that archipelago Scott's been looking for his entire life (and I'm also here to tell you that that archipelago is The Philippines) guys will have the following thought process:
-I am cold. I must put on a jack--
-Wait no then I wouldn't look cool I mean I don't need a jacket, jackets are for people who are weak (or at least, don't like the cold I mean can't handle the cold...)
Notice how disjunctured that is? Yet I bet that it's real fuckin' familiar to a lot of you reading this.
If I had to make a guess, it would have to do with the difference between how girls and guys perceive the cold, and where in the societal hierarchy they see themselves.
A guy with a fear of not finding a mate would do all he can to prove that he's the toughest (i.e. not wearing a jacket). Obviously this is a problem, but why? What is the source of it?
Because we all know that a "sensible person" wouldn't care about "trying to look cool", and so they would instantly put on a jacket (or fashion one out of beautiful banana leaves, right here in the Philippines!)
But the only people who would do that are people who don't understand just how high in the social hierarchy they already are, and so feel no need to prove to the cold that he's better than it.
On the other hand, the guys not wearing their jackets their mothers made and/or were handed down from their older brothers, who might have internalized a feeling of being "low on the totem pole" (which by the way, don't exist in the Philippines), or guys who were generally unattractive or ugly (or any sort of reason such kinds of people would like to insert for yourself here), would try their hardest not to think that the reason they were trying to not put on their jacket was because "I'm a real man!".
If you don't believe me, go ask a girl what she does when she feels cold.
And also, read Sadly, Porn again, but this time, don't skip over those blocks of text you think you're better than. That's where the secret to this lies, you skimmers.
And thus, I recommend the Philippines for anyone like you (I wanna look cool, have freedom of movement, and feel light too y'know).
'Cause the only place to be all of those things without having a jacket is some warm temperate climate. The archipelago stuff is just for if you're one of those TRUE rationalists.
No way. Walking around in 2 feet of snow in Wisconson swinging an axe and being so hot you need to roll up your flannel shirt sleeves is hella cool. At least I assume, I've only did the walking around in 2 feet of snow in Wisconson part, but I have to immagine if I some some burly dude splitting frozen wood like that I'd think its hella cool.
I'm very sorry you think Edward Teach has anything meaningful to say. beyond "I think I am the only adult on the face of the Earth and desperately need you to know it." Yes, I am an evil narcissist who doesn't desire anything except to deny other people their desires. Yes, yes, Lacan is right about absolutely everything. Despite all these things you know about me- even when I'm interested in going on a date, I wear a comfortable jacket. This is because I don't like being cold and couldn't give less of a piss about whether someone sees me as "lame" for wearing a jacket. Someone who sees other people as "lame" for wearing jackets isn't someone I'm interested in dating to start with.
Yes, yes, I'm too stupid to REALLY understand Sadly, Porn too. Poor Cro-Magnon me actually assumed someone SAID what they MEANT instead of engaging in triple-reverse-corkscrew psychology with a side of moon logic to derive the secret TRUE meaning from it.
Please, for a single moment, imagine a non-Filipino person might be driven by something besides facile status games.
Νο, maybe just phallus status games. But even then, the Filipinos are great at that too! (See also: the rates of homosexuality and Catholicism in the Philippines.)
I have never tried therapy, but there have definitely been instances where I had a personal problem and after much consternation either said to myself or had someone say to me "dude, why don't you just [really obvious solution that simply never occurred to me]?"
In our society, there seems to be very little formal development on how to understand oneself, others, and the world. Meanwhile, informal development is provided by family (with a huge variance in amount and quality) and society (which today means navigating hundreds/thousands of competing narratives). As such, there may be quite a few people still at very early stages of development when it comes to things like emotional intelligence. Therapy is a form of such development (at varying levels of quality).
To give an example that can maybe spur discussion: what makes the golden rule so golden in our society? I view it as a developmentally infantile and self-centered approach to understanding interpersonal relationships. "Do unto others as you would others do unto you." This requires giving absolutely no thought, modeling, or sensitivity to the mental states of others and yet it's often used as a paragon for interpersonal behavior.
On the one hand, something like "try to understand Jimmy's mind-set" seems like low-hanging fruit. On the other hand, I'm not sure that 95%+ of the population has ever been given any tools "to understand Jimmy's mindset".
My wife and I were wondering if it was always like this, or if we are living in an especially inept era. Perhaps in simpler societies, where there is high default sharing of values and behaviors, default emotional IQ is higher. I wonder if therapy is more or less necessary in such places.
I only know the local situation in Czechia and I can say that there is zero formal development. I personally think that this really sucks, because knowing your cognition, body, how to communicate and relate, that is utterly essential for your life. Actually without being told how to decide and orient yourself in the world, you will probably just spend the whole life tripping on various narratives, and that is like running on the mine field. People want to have the freedom to do whatever stupid shit they want and feel like, but nobody wants the responsibility for all the obviously bad decisions you were even told about in the first place. This is just blocking all progress IMO.
Regarding EQ, when you go to a psychologist, they will probably tell you about a version for kids, i.e. regular people, which is just yet another schema. I really feel like crying when I see how people know absolutely nothing. So much extra suffering.
Of course I can't help myself because I'm a therapist... a few random thoughts.
One is, I too have my own questions and doubts about aspects of my profession. I won't go on about those here, I'd have to start my own substack for that. All to say I'm not a cheerleader for my profession, but there are some aspects of its use that are not too hard to understand or communicate, I think.
You're not wrong in saying that many people go to therapy to get help with defective, deluded, distorted aspects of their thinking that are hanging them up in their lives. We do all have these aspects to us. That can work fine for long periods of time or in many circumstances, until we get thrown some curve balls of particular kinds and then our normal, human distorted thinking habits can cause us a lot of trouble. So...
The kind of people i see getting help with certain kinds of therapy:
* survivor of trauma, whether sexual assault or violent crime or natural disaster, etc. Your average friend or family member is not well disposed to handle traumatic material relayed to them, so friends and family can be of limited use sometimes initially, depending on the disposition of said friends and family. Debriefing traumatic experiences in a structured way can help a person recover and/or head off more lasting problems. Friends and family are essential though in addition, and I would say that for all these situations here...
* person going through a stressful thing and needing a safe place away from stressful thing to consider how to respond to stressful thing: divorce, terrible medical diagnosis, considering the end of a long relationship, considering a career change, bullying at work or school, heading towards retirement, recently relocated and without local social supports, adjusting to having kids or becoming a blended family, losing a child, and so on. There are so many circumstances like this where a basically healthy and mentally sound person just needs a grownup to talk to so they can sort through all the various feelings and thoughts, and often conflicting priorities. To basically listen for their signal in all the noise of the event. This is more like coaching, but is not reducible to supportive therapy, and often people's default modes hang them up in these moments so that something well beyond supportive listening and coaching is needed for them to navigate the change life is demanding of them.
* person in young adulthood -- say until age 45 (only sort of kidding) -- who experienced various kinds of emotional neglect (from quite benign to really malignant) and therefore failed to develop a sturdy inner guidance system. Mildly shitty or narcissistic parenting can leave a person constantly looking over their shoulder, paralyzed by all kinds of self-sabotaging habits, or just unable to identify and name their own internal experience or what they might want to guide them through life. Your writing above seems to suggest you underestimate how common this is and how impairing it can be. This person often has trouble attracting and forming close friendships with people who are wise and stable, and so they do not have in either friends or family the kind of steady other person to help them solidify a sense of self as distinct from all the bullshit they internalized growing up. Short or long-term psychodynamic, among other approaches.
* person who is trapped in long-standing cognitive patterns that feed their natural inclinations towards anxiety or depression. CBT, exposure therapy, mindfulness, etc.
* person who has developed behavioral habits to try to self-treat their underlying anxiety, depression, trauma, etc -- addictions, compulsions -- that have grown into their own additional sources of impairment. They may need a mix of all the things above depending on what's driving the behavioral compulsions.
* some people are external processors, as you suggest, and regardless of how nice their family and friends are, they need more time and audience during stressful life periods in order to hear themselves think. Sometimes these people want to talk about things that they don't feel they can share with their friends or family. Coaching, CBT, ACT, etc.
* some people face existential fear or existential predicaments that they likewise need a trusted other to talk through in the way one might have used a priest in a prior era. This work can be quite deep and rewarding and definitely isn't just supportive.
There must be therapists out there who only do "supportive therapy" but my understanding is that that's an expression more used to describe specific sessions here or there. "Client was highly distressed at news of mother's cancer diagnosis; intervention this session was mainly supportive." In other words, there are times in the course of therapy that the most appropriate response by the therapist is simply support, but that doesn't constitute the whole of a treatment plan. A person comes to you thinking they may want a divorce... after some sessions, they show up saying they told their spouse and now the separation is in process, and it's clear the job of that session is just to catch the grief or fear the person is experiencing at having made this choice and acted on it.
Otherwise, I think even the most in-the-moment therapists are operating at multiple levels of planfulness in terms of what they think they're doing with a client at any given time. I mean, of course YMMV. But the idea that it's a sea of "supportive therapy" out there seems inaccurate to me. The training, of whatever school, is definitely not mainly "oh, that must be hard" and nodding sympathetically. The entire arena of case conceptualization is aimed at helping therapists and clients come up with a reasonable story about what they are doing together and towards what ends, and to check in on that along the way. I have that case conceptualization in my head every time I meet with all of my clients -- and I don't work from any single modality so I'm not implementing any kind of manualized procedure on people.
Having said that, there are for sure clients who just want someone to talk to every week or every other week about whatever the hell happened for them that week. In my whole practice, I have a couple of people like that. It's pretty clear to me that my work with them is to address very entrenched personality adaptations to really significant trauma, and the stuff of their daily life is the arena of practice -- literally, how to have healthy friendships, how to set normal boundaries, how to self-soothe, how to name one's emotions and not have to act on them, how to allow oneself any amount of pleasure, how to make decisions towards one's own benefit, how to advocate for one's needs in multiple situations. That work can go on for years, and it is slow, but it absolutely yields improvement in that person's functioning every single year. I wouldn't be able to do it any amount otherwise, because I'm an impatient person.
Quite apart from the kinds of "clinical skills" that these above situations may entail, my experience generally is that most people are not great listeners. Our own narcissistic stuff enters so quickly into conversations with loved ones. Also, so many people are made very uncomfortable by other people's difficult feelings, so that support from one's friends and family runs into pretty hard limitations (minimizing, deflecting, fixing, etc) when one is faced with genuinely tough situations.
Thank you, thank you, thank you, thank you. I am *extremely* appreciative for everything you've written here with emphasis on your third bullet point, especially "Your writing above seems to suggest you underestimate how common this is and how impairing it can be."
No, rationality is not the be all and end all and it will absolutely not be sufficient to help many people with the sorts of troubles they are facing in their lives and relationships. I am stunned and disheartened to read this post and the comments. It leaves me despairing for the state of our humanity.
Great reply, one showing much more nuance regarding the field than most responses here (of course consistent with the fact that you are a therapist). As someone who has tried a fair amount of therapy, I would add that the quality of therapists varies dramatically. I'd say 8/10 are worthless, 1/10 may provide modest value, and 1/10 is extremely valuable, perhaps corresponding to the 1/10 who has mastered the various approaches outlined in your bullet points above. In my experience traditional credentialing and licensing systems provide essentially no information on whether or not a particular therapist will be valuable or not, so one has to find networks of trusted friends to recommend the good ones. I see much of the negative perception regarding therapy as due to the fact that most are, in fact, worthless. But simply because our credentialing and licensing systems are failing to provide any relevant guarantee of quality does not imply that all such practitioners provide no value.
My hunch is that really good therapists can help most people but that some people are looking for very specific things, or think they need very specific things, and that makes finding a good match pretty hard. And of course some of it is just chemistry, which matters because it's a much more intimate relationship than one has with many other people in one's life, and trust is so central to it. It's a common experience as a therapist to have clients say, "I've never talked about this with anyone else in my whole life," including from clients with very close, long-term relationships.
I've also been a client in therapy many times and I know I can be pretty fussy about what I'm looking for in a therapist, though not fussy in the same way as some other people I know, so I'm aware we can be fussy in very different ways that would lead one therapist to go right to the top of one person's list and right to the bottom of another person's. So that makes it hard to talk entirely about "good" therapists and "bad" therapists.
One of the things I think about a lot is what can be communicated fairly quickly at the beginning of therapy to help clients make good use of therapy. Some people come in ready to get down to work and able to make good use of the time and the therapist while other people can spend a huge amount of time (and money) just kind of spinning in default mode (I know because I did it for years as a younger person). A lot of this has to do with how the person's defenses are organized, how self-aware they are coming in, and how open to learning they are.
Many people who go to therapy have the idea that it's like getting a massage, which is fine if that's what the client and therapist want to do. Like "Where is it tight this week? Ah, over here on the left side of your neck, we'll work on that today."
For anxious people, this can look like them bringing in a different worry every week and the client and therapist talking about the content of that particular worry, doing CBT on that worry, identifying the distortion or proposing a practice to deal with it or whatever. The therapist is always doing some version of reassurance and problem-solving at the content level. But there is NO END of things an anxious person will worry about and there will be a fresh worry every single week (or more of the same old worry in slightly new clothes).
And I do think it's a disservice to clients not to say to them, "Hey, we're not here to comfort this week's worried thoughts; I'm not a crutch to help you get through daily life. This is a learning process where you go away with new capabilities to relate to your content." Therapy is intended to help a person relate to their thoughts and feelings, differently, which requires that they begin to pay attention to them at a more meta level, and that they stop investing so much reality in the content-level stuff. Many people have a lot of trouble doing that and their whole lives are basically always lived at the content level, reacting to the bumps in the road as they happen. Their default mode encounters fresh content week after week, but without the capacity to turn and look at the workings of the default mode, to increase awareness about how they relate to their experience overall.
Anyway, really high up on my list of what makes a good therapist is can they help a person investigate the workings of their default mode and do they have the skills to help that person figure out where to take it from there (and for each client the "from there" is going to look somewhat different, so there's no manual to follow).
And yes, totally, what you say about how bad the information is to help potential clients figure out what kind of therapist might help them. There are so many things broken about that part. There are so many fads in therapy -- CBT, ACT, MBCT, EMDR, IFS, MI, body-based therapies, blah blah blah, every twenty years a whole host of new clever acronyms that don't really amount to a hill of beans, but lots of insecure therapists chasing the next great thing (or building their trademarked empire on it). And then you have people's doctors saying, "go find a therapist who only does cognitive behavioral therapy because everything else is a waste of time." And that's nonsense as well.
If a client comes my way saying "my doctor said I need a therapist who does CBT" I'm likely to decline that client, as will most of the more seasoned therapists I know. It would take a lot more words to explain why, but it points to one of many disconnects in the process of a person navigating this whole mess of a system. Word of mouth is often the best way.
How is it that in a rational community dichotomies are entertained? Is it this way or that way for all? Or this way or that way for an individual? Given I've found these two approaches completely unreliable and crazy-making, I'm going with "What types of therapies are useful for any one personal are individual and extremely custom, and therefore rolling that up to the masses, as public health has to in this case, any public heath recommendation should not be followed blindly by an individual. Same caution for root-cause analysis - there are usually more than one cause for complex issues. Sure one may seem like the root, but resolving it may not in fact resolve the problematic outcome. Oh, how I wish the many doctors I've had over the years were more systemic thinkers.
The way that I would put it is that people think the purpose of therapy is INVESTIGATION when in fact the purpose is CONFIRMATION - and confirmation is hugely valuable, at times.
Thanks for confirming that fact I thought myself first before reading your comment. Maybe the real psychiatrists that people should be looking for are people who claim to be time-travelers.
Exactly. If we feel we're being gaslit or misunderstood by certain actors in our lives, having an impartial witness to validate our intuitions (or contradict them even!) can be the reality check we need but can't get elsewhere.
This seems to be more of (but of course not exclusively) a woman thing. Hence the old idea that when a woman complains about something to a man (and the complaint isn't related to the man's behavior), the man will offer solutions to the issue, but the correct response is actually for him to tell her that she's right to feel aggrieved and that what happened to her is a true injustice (or words to that effect).
Well, one can sympathize with someone's upsetting experience while not necessarily confirming they were in the right. Sometimes just offering comfort is the gateway to then gently helping them see what their own responsibility was in the matter. Any good listener, especially a therapist, should understand that.
I have written this before. I tried classical Freudian therapy for my depression. Years later I tried Zoloft. The Zoloft worked. The downside of the Zoloft was weight gain. Freudian therapy didn't cause weight gain, and it didn't alleviate my depression.
Possibly a stupid question: Has anyone made a serious attempt to construct a _list_ of all of these fundamental skills that most people have but a few people are randomly missing?
If that's knowable, but not currently known, it sounds to me like figuring that out would be worthy of being some brilliant scientist's life's work.
I know that professionals who work with developmentally-challenged people have some sort of list of milestones they use to approximate a patient's developmental progress/"age", which seems like it might overlap or be a starting point? But I don't know much more than that it exists.
Is there any evidence about people who's internal monologues ebb and flow? I have had a rich inner monologue at various times of my life, with droughts and many things in between. I find that I process many things verbally, often not realizing some emotion or preference exists until I voice-dictate it in to Daylio. I also love supportive therapy!
Re therapy and money, my favorite thing is how therapists justify the cost as "it has to cost a lot so you're invested in the outcomes". Which does make sense, to a degree: skin in the game. And yet, it's also what a psychoanalyst / TLP would call "a defense".
As far as "supportive therapy" goes, I totally agree. It makes me think of something Eric Berne wrote, about how there's 4 "levels" of therapy:
1. symptomatic control
2. symptomatic relief
3. transference cure (substitution of therapist for parent)
4. psychoanalytic cure (reveal the patient's fundamental conflicts)
My guess is that most supportive therapy takes place at the first two levels ("tell me about your anxiety" ... "are you feeling less anxious?") and MAYBE the third level. But it will never approach fundamental conflicts, although this isn't necessarily a bad thing, because, like with meditation, that's a door that you can't really close once you open it. Most people are happy to "return to society" after getting whatever support they need. Only in some cases does one need to go further.
My mom, a professional psychotherapist practicing "supportive therapy" (well, she'll call it "cognitive-behavioral with a psychodynamic bent"), has an anecdote from her years in therapy. She apparently reached a point where her therapist told you "this is as far as we can go together. If you want to dig deeper into your conflicts, I can refer you to an analyst." I don't think she took up her therapist on that offer, but to me it makes sense: there's different levels of interventions, that tackle different things and require different modalities.
Just chiming in regarding the internal monologue bit- I don't have one, and I am thankful for that. Having to think using words all the time sounds exhausting! I have no trouble using them as needed, such as posting this statement, or talking to someone. But I would say 90%+ of my thinking hours are spent considering concepts in a non-verbal manner. That doesn't mean that I don't have access to introspection. It just means that converting thoughts to words comes after the fact, not during.
I’m beginning to think that the word monologue used to describe this internal process of thinking through something is perhaps misleading, as it has a very direct connotation of spoken words.
Words are metaphors and I think it’s very difficult to engage in meta-thinking without metaphors being operative. It might even be impossible.
The metaphors might not be language but I find it difficult to imagine that any thinking human being does not have some sort of inner “monologue”By which I mean metaphors of some form. I would propose that language is the basic metaphor that is used to pursue a train of thought But with facility it can become second nature for want of a better term, and thus less visible.
Practicing at sport until it becomes muscle memory is an example.
I think I don't want a therapist, really. I want an expert. I guess it's why I follow Scott here. I feel like I've got a solid grasp on my problems, and even a decent idea of what I ought to do to solve these problems. But I wouldn't mind talking with someone who is an expert in how the brain works and has experience in how to attack depression and anhedonia.
Would be cool if this expert could prescribe ketamine as well; I think that might help.
Boring take: people used to go to their local religious leader for the kind of service they now get from a therapist. But now they don't believe that person knows anything, or don't want to be alone with them, so they need to look elsewhere. But advice has always been what some people needed but not others.
Having a wise and confidential person in your life seems like a good thing, and giving advice involves triage. That makes it hard to make any general statements beyond "we expect people to know a lot of things" and "when you learn you don't know one after you were supposed to, asking for help can work" but also "getting bad advice is bad" and "authority doesn't guarantee correctness".
Now, from the therapist's perspective, it's helpful for triage if you know what's generally going on in someone's life without asking. If they're depressed this week but last week you spoke at their grandfather's funeral, that's what you might call a clue. And you'll share a cultural context in which to broach some difficult topics. If we've successfully split that role off, great! If you get a bad therapist it's easier to keep shopping than for a new priest or rabbi. But we shouldn't expect that specialist advice givers and generalist advice givers have a totally obvious and easy tradeoff.
Personally, I've tried therapists twice. The less bad one was merely useless and expensive. The worse one taught me genuinely harmful ideas that I spent my teenage years methodically forgetting. And then I got stomach surgery and it cured my depression immediately, so figure that shit out. I've given and gotten life-changing advice, so I'm convinced it exists. I've never gotten it from someone who promised that on their business card, but I have to imagine it's possible.
For what it's worth, the most consistently useful advice for people in my experience has been to not imagine your mind like a pilot flying a plane, where it's just you and everything is on you, but more like a captain on the bridge of a ship, in which you have a lot of voices and specialists and your job is to synthesize them all and make command decisions. Yeah, lots of people have a weird voice in their heads that they don't like. But if so, that isn't all of you and you can isolate each component voice. A good captain knows where their subordinates are coming from. Not a panacea but it's helped a number of people.
I don't know whether this is as big a problem for men, but if women go to a local religious authority, they're at risk for being told to stay with an abusive husband.
I am a SMART Recovery facilitator, and it has become incredibly obvious that sometimes people just need to think things out loud in order to get to the next thought. In fact, there's a famous computer program debugging technique called rubber-ducking because of the story some guy told of his boss keeping a rubber duck in his office and inviting his programmers to come in the office and discuss their programming problems with the duck. It works. I can't tell you how many times I've been stuck in a bug and just explaining it to someone *who doesn't even understand what I'm talking about* is enough to make the answer blindingly obvious. This really is a way of hacking the brain. Sure, in SMART Recovery we say we don't give advice because of the motivational interviewing principle of people will follow advice if they come up with it themselves; but I fully believe talking to someone or something else is just a simple hack of the way our brains work. I've watched too many people decide to get their lives in order and live a life they don't want to relapse from to come to any other conclusion.
Anecdotally: I don't have an inner monologue, and yet I definitely think my problems through. My experience of not having an inner monologue is that you're directly thinking through the concepts without bothering with "shrouding" them in language; trying to debate matters "verbally" (albeit in my head) seems to me to *obscure* the issue more often than not. As a result, my prediction would be on people like me finding therapy/conversation *less* effective than those for whom the discussion with the therapist will be a much rawer translation of what's ordinarily going through their heads.
You gather correctly! I realise it sounds somewhat woo-ish/pretentious to claim that I'm straight-up reasoning about abstract concepts, but I'm struggling to find another way to put it. (Well, I *can* also picture mental images fairly vividly if that's what the task calls for, of course.)
I have been very interested in thoughts related to how to reliably increase the agency of talented individuals, especially at scale. One of the many challenges here is definitely that everyone's' conscious experiences, world models, and self-models, are incredibly diverse, and it's very hard to learn a comprehensive representation of someone's internal structure in order to know what should be optimized (let alone how one would go about optimizing it, even if you instantly knew what should be changed).
I'd love to see any resources on how to increase the agency of individuals (bonus points if talented individuals + at scale) if anyone has any favorites to share
yeah, e.g. encouraging people to start/create more things, cold-contact more, and in general just significantly up the baseline for how much someone maximally modifies reality to achieve their goals rather than accepting it as a given
I've been noodling on the idea that one pathway for therapy to be effective is to develop a secure attachment to at least one other person on the planet. This came about after reading the transcript for this podcast: https://www.janetlansbury.com/2021/03/the-truth-about-secure-attachment-with-bethany-saltman/ which is more about parenting, but it makes sense to me that everyone could do with having the experience of being fully themselves in front of another person and not being rejected but just quietly accepted instead.
> "Then they are delighted and go home! I sometimes think about this by analogy to “you can’t tickle yourself” - some people can’t reassure themselves either, and are very happy to hear thoughts they could have easily generated themselves coming from other people’s mouths. Are these some of the people who benefit from therapy? Seems plausible."
As someone who had/has an anxiety disorder that occasionally resulted in semi-obsessive episodes over some real-or-imagined danger, I can confirm that "people who can't reassure themselves" is indeed a real thing, and also that many of these episodes were resolved precisely by having a doctor (or other relevant knowledgeable person) tell me something along the lines of "this isn't even plausibly worth worrying about, go away."
This isn't so much about the reassurance factor of a trustworthy labcoat-wearing authority figure (although that may help), more it's about simply having an external reference point to calibrate against. An ordinary person sees a garden snake, isn't scared, and goes about their business; someone with anxiety sees a garden snake, feels scared, and suddenly has to decide whether this is just their anxiety disorder acting up or if it's their pre-reflective common sense telling them they're in real danger of being bitten by a poisonous snake that looks like a garden snake. This is a surprisingly difficult thing to solve through introspection and self-talk, since these processes rely on precisely the kind of fuzzy intuitive faculties which are malfunctioning in this case. But if someone just tells you that, no, their fuzzy intuitive faculties say everything's fine, you have some solid evidence to decide in favor of the "I'm just having an anxiety attack" hypothesis, and can move on.
(At least, you can move on to the stage of simply gritting your teeth and trying to tune out the parts of your brain that keep yelling that you're in mortal peril, but progress is progress.)
That's all an example in the case of anxiety, but I'd imagine "therapist as a reference point for internal calibration" is a broader phenomenon. Humans have *lots* of fuzzy intuitive faculties, and many of them concern judgements of very private things you don't usually talk about to someone aside from close family and friends (who are liable to have similar problems to yours!) and therapists. It's probably very easy to go through life with badly-calibrated intuitions for how people feel about you, or for your general prospects in life, or for how to navigate intimate relationships -- even in cases where a simple explicit check-in would correct the problem. Therapy is, among other things, how our culture administers these check-ins.
> "This is a surprisingly difficult thing to solve through introspection and self-talk, since these processes rely on precisely the kind of fuzzy intuitive faculties which are malfunctioning in this case. But if someone just tells you that, no, their fuzzy intuitive faculties say everything's fine, you have some solid evidence to decide in favor of the "I'm just having an anxiety attack" hypothesis, and can move on."
yeah, when you're in the throes of an episode, that little internal reasonable voice about "now I know it *feels* like you are dying but you are *not* dying" is no help at all. External source is much better. Like the doctor who, when I was bleeding like a stuck pig (women troubles) was very matter-of-fact and prosaic about "oh yeah, this happens" and gave me a prescription for medication and told me it should stop soon but at the very most it should stop in two days. Immensely reassuring and brought me down from the panic faster than anything else.
I think a lot depends on the context too. I'm generally psychologically healthy, but I benefited tremendously from a grief counseling session after the death of a parent.
We as a society have always needed calm, wise, objective people to help us talk things through. Back in the days when most people were religious, priests, ministers, & various clergy members often performed this calm listening function. In Asian/African cultures, it was often village or community elders. Therapists have taken their place. But the need has always been there, and societies have found ways to meet it.
I'll lend my support to this: when I slipped into a deep depression over the death of my aunt, I needed a therapist to help pull me out of it. After getting out of "the hole", I was able to take in better ideas that have so far kept me out of it, and I don't need a therapist at this point. If I end up on a hole again... well, I could turn to a therapist, or to a monk I know- both seem to function on roughly the same level in terms of getting-people-out-of-holes.
I was surprised when I heard that some people don't have an internal monologue; it made me wonder how their decision-making actually works. Apparently there are also people who have no mental visual imagery either. Now I wonder what people with these deficits think about the rest of us; do they suspect we are hallucinating? Hearing "voices" and seeing "visions" would only be a more extreme form of these mental processes.
I am not sure, cause I kind of have the opposite impression, at least for internal monologues: it feels like a semi-failure of decision-making. It's not that I lack internal monologue, but most of the time it is not present, or at least I do not consciously realize I am speaking to myself. When it happen, it's because the decision is hard to reach and there is a lot of back and forth change of mind, pro and cons being re-evaluated...
This is imho the mark of a very inefficient process, exactly like reading by "speaking in your head" is slow/tiring. Not as slow as reading aloud, but much worse than not even thinking about the sound.
But when you explain to people learning to read (sometimes reading aloud) that to get better, they should stop mentally pronouncing the sound, that it's the next level in term of speed and effortlessness, they look at you like you are crazy: Thzey think "how would I read if I do not pronounce the word, at least mentally? It would not be reading the words, just having a quick look at a bunch of letters?". And they will be right, I think at first you lack direct connection between visual pattern recognition and meaning units, and reading without (internally) making the sound is just not possible.
Internal monologue is maybe the same kind of crutch to decision making as mentally reading aloud is to reading: the proof that you are inefficient and struggling in unknown territory, instead of doing something really well (a direct connection between set of informations and goals, and an optimal chain of actions, probably because you had done something very similar int he past) . In fact, if I look at the time I remember the most vivid internal monologue when deciding, it's exactly that, and a sign that my decision was likely quite shaky...
Well, yes obviously. I really only use internal dialogue for difficult decisions or for when I am preparing to do public speaking. And I have not "pronounced" words whilst reading since I was very young, unless it's poetry.
And do you think internal monologue helped, compared to non-verbal decision making (aka do what feels right, do not overthink it)? Honestly, I do not think it does. And If the self/inner voice is mainly an a posteriori, rationalization (in the form of a single-threaded story) to a multi-agent parallel brain (probably mostly usefull to organize memory) ( A view quite popular if not dominant in the neurosciences), internal monologue is in fact a failure/inefficiency of this process, not really a way to improve the end decision...But It may improve the story about the decision though, to be told to yourself or others. Which is also important, but in antoher way (make the decision more socially acceptable I guess - which would predict that inner monologues should be associated not to difficult choices, but difficult justifications )
There seems to be an idea here that the internal monologue is a weird outlier, but it is far more common than not, to the extent that most people were surprised that some people didn't have it. What do you think those voice overs in movies are all about? Stream of consciousness is a term dating back to the 19C, and Daniel Oliver, the guy who invented the phrase didn't claim that it was rare - he was describing something that we all were assumed to have.
So it's odd to find out that this isn't universal in 2019 or so, and also to be on the internet and find that a lot of people , seem to not have it . Maybe that is because of the nature of the internet, or this blog? Its odd that we just found this out.
Anyway, my own inner voice isn't really a hinderance to other thoughts, I can be thinking word thoughts and solving puzzles at the same time. Ideas come and go.
Speaking as someone who doesn't mentally sound out words while reading, I'd say I just... become aware of the meaning? I don't know if there's a clearer way to express it than that. When multilingual people hear someone speak in one language they understand, do they have to mentally recite the words in another language before they process it as meaning? Speak very little of any language other than English, but I don't think it usually works like that, they just understand the words in the language they hear them in.
I think it's essentially like that. The written words are already an expressed form of meaning themselves, I don't have to convert them into a different, audible form to understand them, I just understand them in their visible form.
I don’t know if the multi lingual thing works as an analogy. Both are languages.
When someone speaks do you hear the words? To me that’s no different than writing, in fact if a friend writes to me I hear his or her voice in my head. For a novel I can hear the accent of a person speaking if I know it, and the voice is also gendered. Narration is neutral or in the accent of the protagonist if it’s a first person narrative.
If someone is telling me a story I see the images, as well as the words, which fade into the background. Same with a well written novel. I can’t do that with non descriptive prose though, I read your argument in my head in a neutral accent. I don’t picture your argument, but if you started on a story to illustrate your point I would start to see images.
(The neutral accent isn’t American or my own Irish accent. Hard to explain but very bland).
Written text is also a language; I don't need to translate it into a different form to extract meaning from it.
For me, the notion of needing to hear words in my head to understand writing is just strange. The sounds aren't the meaning, the sounds are a symbol intended to elicit meaning, as are written words. The meaning exists in my head independently of either. I *can* imagine actual speech in my head, and I do so when I write dialogue, but it's much more effortful than just parsing the meaning. When I read your message, I don't ascribe any sort of vocal character or accent to it; it's as much a category error as trying to express what your message smells like.
As someone who actually has little to no mental imagery, I absolutely do not think that people who do are hallucinating. Because I was socialized with people who did have the ability to form mental imagery, the way you describe your thoughts became the way I describe my thoughts. If you ask me to picture an apple, I will say "okay I am picturing an apple."
What I'm actually doing is collecting a list of concepts that apply to an apple: apples tend to be red or green, they're mostly round but they have little dimples on the bottom and a stem at the top. Until late in life I thought that's what picturing an apple *was.* I was often impressed by how many details about an object a person could hold in their head at once, but I never thought they were hallucinating. I just thought they had a better ability to perform the above process than me.
The only time I've been baffled or confused by the concept of "imagining" as a visual process was when I was trying to improve my memory, and books kept asking me to form a "memory palace" where I could "put" the different objects I was trying to remember. That's much more work for me, so it seemed like an insane person saying insane things.
But tl;dr: The words people use to describe their thoughts are just words. And since they're in common usage, and since I've never seen the inside of another person's thought process, I just automatically analogize to how I think.
Supportive therapy was most useful for me when I was a confused ball of emotions about some ongoing or recent trauma.
A kind, steady, professional listener was helpful in those cases to help me figure out… where I was overthinking and where I was under thinking.
As I get older that seems less useful because both me and my friends have grown wiser and emotionally more capable, so we figure out 90% of that between ourselves easily. That seems like a common pattern.
I’ve never found supportive therapists to be useful in developing myself, though plenty of other things have been, including fairly mundane things like corporate management training.
Question for author - what are the areas of “basic human functioning” in which you suspect you may be deficient? I guess the term “deficient” also needs a definition, but it’s the same framing in your final paragraph, and I’d be curious to hear your answer... It struck me as a sentiment that is admirable for its vulnerability, probably universally true, and potentially interesting area to explore further. What thought patterns, aspects of self-awareness, intellectual qualities, interpersonal behaviors, etc. qualify as essential to “basic human functioning”?
Maybe this is merely tangential, but most of the value I perceived in seeking a professional for improving mental health is through the use of tools, exercises for psycho-social intervention. Therapy is one way to acquire them, another is just picking up a workbook for popular forms like CBT or 3rd wave CBT. My impression is that therapy is not usually about this, unless you explicitly seek it out. Maybe that's a problem, since in popular discourse everything is conflated.
When it comes to questions like "my job sucks, what do I do now?", you confide in people you know or look online. If the problem is depression or ennui, I think talking is insufficient.
Some things are easier to see from a distance and to be seen clearly by someone for whom doing so isn't emotionally expensive. I know I lived with faulty assumptions about myself that would have been difficult to have intuited or reflected my way out of. Maybe what I got wasn't "supportive therapy" but it was incredibly helpful.
As someone who was handed a bundle of really unhelpful ideas as a kid (see: Evangelical Christianity), and whose university experience only reinforced and expanded those bad ideas, therapy was extremely helpful to me.
I was depressed, isolated, full of self-loathing and inner conflict, and literally had no one to turn to who could actually help me, because I had spent the last many months pushing them all away. My quality of life was complete shit, and it was well worth $100 a week to improve it.
I’m not saying therapy is always worth it for all people. Some therapists are terrible. Some people are relatively psychologically healthy. But that’s certainly not a given. For many, therapy is a lifeline.
Joshua, I'm happy to hear that you improved your situation. Good wishes to you, I hope you continue to make things better. My experience is similar, I received a lot of bad programming as a child; I stumbled upon cognitive therapy in my late 20's and it helped me a lot.
Also, I hope you don't mind me saying I'm fascinated by your story: raised Evangelical, graduated from Bob Jones University, and now commenting here. I think this says a lot about the diversity and acceptance of this community.
Thanks, Banjo. Indeed it does say a lot about the diversity and acceptance of this community. It also speaks to the power of ideas to transform a person’s life. I left faith about 10 years ago, and I have been dramatically happier.
I can't imagine ever paying for therapy now--I'm somewhat too private. I feel a need to write journal entries thinking things through when I'm upset or having difficulties, but I'd rather think everything through on my own. There's lots of things I wouldn't share with my spouse, let alone anyone else. I guess I also doubt that another person would be able to do anything for me that I can't do for myself.
However, my 2nd-grade teacher referred me to the guidance counselor because I seemed sad a lot or something, and that lady has a very warm place in my heart. I told her all about my mildly abusive family life, and she told me that it was wrong for my parents to treat me that way, that there was nothing wrong with *me* that was causing this but that unfortunately some parents just don't treat their children the way they should, and that I should remember not to treat *my* kids this way when I grow up. Then she sent me on my way after a few meetings.
I think those were exactly the right things that I needed to hear; they really stuck with me. I'm not sure, for lack of a control, but it's possible that those meetings helped to inoculate me against some of the normal negative psychological consequences of a mildly abusive childhood: I never had any self-esteem problems, and was never tempted to think that any of it was my fault. She also shared things about how *her* family worked, which helped give me a healthier picture of what "normal" looks like which was different from what I was seeing at home.
With adults, alas, it's too late to inoculate, but some of that sort of thing could help an adult too.
So, the linked article about internal monologue is actually discussing inner speech. This might seem like a meaningless distinction, but if you asked me if I have an internal monologue, I would say yes, but if you asked me if I have inner speech, I would say no, or at least, no given my best understanding of what that's intended to mean.
As people go, I'd say I'm a pretty highly introspective person. I spend a lot of time thinking about the information I have to construct my understanding of the world, my own feelings and motivations, the feelings and motivations of people around me, etc. I think from my experiences I can say that I'm better than most people at predicting how I will feel or act in various circumstances, and how various life changes will affect my mental state.
But, I don't conduct this internal monologue in words. I *can* process thoughts in words; I write fiction, and when I write dialogue, I play it out in my head to check how natural it feels. But the idea of conducting all my introspection in words honestly feels really weird, slow and inefficient. Words are for communicating with other people. The idea that I'd need them to express thoughts within my own head feels bizarre, like if moving a file from one location in a computer to another required turning it into a huge verbal description in an MS Word file so the computer could understand it properly.
I don't think people without internal speech are necessarily more introspective than people with it, but I think it's worth being clear that a lack of internal speech doesn't necessarily inhibit introspection either. Some people may almost entirely lack introspection, but this would be a different, and probably harder to examine, matter than lack of internal speech. If someone is sufficiently non-introspective, are they capable of being aware of their own lack of introspection? I've definitely known people who give me the impression that they're not.
> But, I don't conduct this internal monologue in words. I *can* process thoughts in words; I write fiction, and when I write dialogue, I play it out in my head to check how natural it feels. But the idea of conducting all my introspection in words honestly feels really weird, slow and inefficient
I am curious about this. Could you describe the form your thoughts take without words.
I understand information that I might describe as somatic in nature; feelings and sensations that inform me, But I wouldn’t call them thoughts.
I'm not sure I can properly describe it except subtractively. If someone told you that they can't process written words without seeing someone speaking them, you could tell them that you experience the same comprehension minus the visual component. For me, I experience the comprehension minus the auditory component.
Hearing other people say that they can't process text without an auditory component, or can't internally process meaning without words, puts me in mind of one of Scott's works of fiction-
...since to me, not being able to separate meaning from words or auditory representation feels like lacking a concept of "getting out of the car." The words are not a necessary vehicle, you can get from one place to another without them, and some terrain is more easily covered without them.
I am thinking of a process of manipulating triangles in my mind, but it’s already DOA because “triangles“.
The need for an auditory support:
I agree with you on that. I don’t have to hear the word although clearly I like to because I usually talk out loud when I’m having these discussions.
I think of the dialogue in a play. It’s one thing to read hamlet and not speak it. But hearing it spoken well is quite a step up from just reading it. There is a quality of concreteness that comes from speaking a word, or hearing it’s spoken.
I think that depends on what you mean by "labeled." They can be more or less fleshed out. There have been a lot of cases where other writers have fleshed out ideas I've already previously held in some less developed form without having names for them. After reading their works where they put names to the concepts, I'll use those names whenever I communicate the ideas with other people, but I don't need to express those labels verbally inside my own head. But, I'm aware of the additional depth they contributed to the concept when I think about it, without having to actually think in terms of the name.
I still remember the first time I realized that other people I knew in grade school actually, you know, did stuff after school, and in a sense "had lives".
I once went to therapy because I was feeling paranoid about an issue. After a few sessions, the therapist assessed that these worries were normal to have and my reaction was proportionate. In other words I wasn't overreacting, I was having a big reaction to a big problem.
Once I heard that, I did not stop worrying a lot until that issue went away, but I did stop feeling overwhelmed by it. The therapist's opinion allowed me to accept that I was feeling big feelings and removed a huge part of why these feelings were problematic in the first place.
Drugs work great for helping some people with their issues- they worked awful for me. Now, this might simply be because I was on the WRONG drugs (this is the psychopharmacologist's usual retort) and being on the RIGHT drugs would have stopped my depression from spiralling and pulled me out of the hole. But they didn't, and the psychiatrist outright refused to recommend my family a therapist until things had gotten much, much worse because he earnestly believed (based on the general thrust of our discussions) that every bad thought or feeling could be medicated away and that the entire field of psychology (separate here from neuroscience and psychopharmacology) was pseudoscience. Now, I don't think Scott believes this- but I think it's a pretty common attitude in psychiatry to think your preferred treatment method is manifesting the destined form of Mental Health Treatment and every other, lesser approach is now an outmode. Talk therapists can fall into this too.
A propos: I wrote in another comment that there is such a thing as non-pharmaceutical intervention strategies that research suggests is generally effective. That could belong to "therapy", but in the common lexicon therapy refers to "talk therapy". I think this confusion does a disservice to people because more would benefit from applying CBT or 3rd-wave CBT exercises.
I totally get what Qiaochu is saying - it's the kind of insight that sounds either like a platitude or tautological once expressed in words.
I noticed people struggling in life don't have that attitude - that problems are solvable, that whatever causes you pain in life is subject to the same approach as a dripping sink or a flat tire in your bike. It seems like you can actually lose this insight by cultural osmosis, if you spend a lot of time with people who have this kind of learned helplessness, you start to reify your problems as something that just happens.
I think the lesswrong alief vs. belief distinction is very relevant here, you can believe "problems are solvable" just fine but it does nothing for you, while acquiring the alief is life changing.
Completely irrelevant to this post, but the "it's impossible to do anything" attitude of my peers is about to drive me absolutely wild, and I'm glad I'm not the only one to notice.
I'm sympathetic to Scott's speculations here about why different people would be helped more or less by therapy. I would add an evolutionary psychology dimension to the story (yes, it's a bit of a just-so story, but that's fine for a hypothesis).
Humans evolved to live in small clan groups, mostly under Dunbar's number. Under such circumstances, one is constantly receiving social feedback from people with whom one has some degree of intimacy, to include authority figures such as clan elders. We may have evolved to rely on such feedback for our problem-solving and basic sense of stability and wellness.
Under modern conditions, we often lack such social feedback, in both quantity and especially quality. Therapy often serves to fill that niche. Some people refer to therapists as "rental friends," but they actually may be more like "rental aunts & uncles."
Oh, I have no problem at all with an inner monologue, or even an inner dialogue. My problem is that I can talk myself right back into where I started from and nothing changes. Having someone exterior that doesn't follow the little script I write for them in the internal dialogue would be so much more helpful.
Absolutely. I share this experience. I’m much more likely to have a reasonable conversation with myself these days but I’ve had quite a bit of therapy and on the whole I would say that’s been a very positive thing.
A quick mind is not always an asset
Conversation wise I mean: internally.
I think it’s more difficult to get a quick mind to listen, thus the monologue.
I would agree with you and many of the others in therapy discourse that therapy-as-a-means-of-just-talking-to-someone represents a large percentage, if not he majority, of therapy patients. Smaller, more atomized families coupled with technology limiting the availability of intimate in-person settings to have these deeper conversations mean that people have to spend more time inside their head. This allows their own cognitive deficiencies and biases to play an outsized role in their psyche, rather than having someone to sense-check or empathize with their feelings.
I think Freud‘s Oedipus complex is a very good summation of the whole whore – Madonna dichotomy which as we all know is a strong cultural trope and has been for a long time.
"Other people obsessively seek external reassurance. I talked here about the phenomenon of hypochondriacs who go to their doctor to be told that their latest concern (maybe the 25th time they had a certain symptom) isn’t worth worrying about, same as the last 24 times. They’re not even asking for an x-ray or something! They’re just happy to hear the doctor say the words “given that your last 24 symptoms were nothing, I’m assuming this one isn’t anything either”. Then they are delighted and go home! I sometimes think about this by analogy to “you can’t tickle yourself”"
huh... i suppose that describes me pretty accuretally. i have that sort of need for external reassurance for a lot of different things, with the added effect that i tend to loss the order i mentally need to continue doing it because i get uncertain, so just having someone to validate it can make me not panic when trying to do it... interesting
I was really hoping for someone to address the "benefit" part. What is the expected/supposed benefit? Obviously some people like to discuss their problems with someone paid to be non-judgemental. Is it done just for this contemporaneous enjoyment? Is there a temporary benefit that wears off over time and it is expected to continue this type of therapy for ever? Is the benefit is to address your problems make some realizations/improvements fix your issues and be healed, then the therapist just lost a customer. My assumption has always been it's the later, but based on the habits of people I know that go to therapy that doesn't seem to be the case. Or as a group they have terrible or fraudulent therapists?
I can say when supportive therapy has helped me and when it hasn't.
The time I benefited from supportive therapy was when I was diagnosed with a major psychiatric disorder (Bipolar 1) and finally accepted it. (I had been diagnosed once before and /not/ accepted it and this only went very well until it suddenly went really, really not very well.)
Having an older therapist who could credibly claim to have seen it all listen to my fears, whether I could do all the things I wanted to, whether it was 'real' or I'd just somehow tricked everyone including myself into, and so forth, as well as being able to make me realize I wasn't the only person this had happened to and recommend a few autobiographies helped me calm down enough to start approach things as a skill to be learned and mastered.
Especially for matters with a stigma about them (or if your family are people whose response to finding out you have a mental illness is to tell you it's a punishment from God), it's easier to be open with someone who has a lot of experience talking to people with similar problems. This therapist said I was done with therapy about the same time I felt like I didn't have anything more to get out of it.
Where it didn't help at all was treating an eating disorder. After realizing I had one thanks to a nutrition blog one of whose authors had /also/ had one and gave the advice that trying to make major changes to your nutrition /without/ addressing an underlying disorder will likely fail, I got referred to a therapist. Who was a supportive therapist and spent three years accomplishing nothing.
Leaving that therapist and going to a CBT/DBT therapist who took a very structured approach, assigned reading material, gave specific behavioral changes to work toward as Thing One, and gave homework like structured journaling was very useful. She didn't talk about my thoughts and feelings except through the lens of stressors, triggers, maladaptive patterns of thought, etc. Exactly how good she was at her job was impressive, I could feel myself going from "I can't imagine giving this up." to "Wow. I don't even like this." over the course of months and she had specific clinically set goals and when I met them, we were done.
It seems like your approach is the one I would assume, the therapist is helping your or teaching you how to address some issue and as such the therapy should be temporary - until the problem is addressed. Theoretically, better the therapist the less time you'd need to spend in therapy. The never ending supportive therapy is seen as a failure.
It seems like a lot of the the "therapy is great" folks do not have the same expectation in mind. The original question "therapy, good or bad" would depend on whether your expectations aligned with what therapist thought there job was?
I have a hard time understanding why someone would pay thousands of dollars over many years to waste time venting to someone. I suppose it's like the difference between going to a physical therapist to fix a bio-mechanical issue or going to get massages on the regular because it feels nice.
People go to therapy for so many different things -- from couple's counseling to ADHD coaching and everything in between. The therapist helps the patient/client articulate one or more goals from whatever the presenting suffering is. Sometimes the suffering is depression and the benefit is alleviated depression. Sometimes the suffering is a bad relationship and the benefit may be better communication skills to improve the relationship or it may be clarity to get out of the relationship.
In general, the benefit is ameliorating some form of mental (and sometimes physical) suffering.
My question is whether that ameliorating is supposed to be temporary or leading to a permanent correction that would alleviate the need for future therapy? From what I've seen once people start seeing a therapist they tend to go indefinitely, which obviously doesn't fit with concept that the therapist is actually providing a good pathway to a permanent fix. I'm wondering what I'm missing here....
The aim is sustained change, but also change can be a life-long process, so it's very individual whether a person wants to continue to work on things in therapy, work on them intermittently, work on new things, or not.
Lots of people go to therapy for a time to address a specific issue and stop when they've addressed the specific issue to their satisfaction. Lots of people go to therapy for a time and then return to therapy another time for another issue or a deeper round of work on the previous issue (that doesn't mean that previously there wasn't change or growth or resolution, only that now more change may be desired). And some people do see therapy as a space for ongoing growth -- whether one sees that like practicing at a dojo or visiting with a priest.
If a person comes to therapy to treat depression and the only way that therapy helps them is during the very hour that the person is talking about their depression and they are taking nothing beyond the hour to practice in their lives, then I would say that's not successful therapy. Therapy is not designed to be a crutch. It's a learning space. People use that learning space in different ways.
I'm not sure if you're being facetious, but I really think there are many people who have "no ability to systematically think about and solve" problems. I know several personally. Perhaps, then. we are too harsh when we criticize people for making bad choices in life. Maybe, as you suggest, they actually lack the ability to make proper choices at all?
The idea that "everyone is defective in some sort of basic human functioning" also struck me. I wonder if this is a trend over time? For instance, were our grandparents and great-grandparents much less lacking as a whole? Is the increase in people in therapy over time because of greater self awareness, improvements in the field and less stigma attached to seeking help -- or because people today are more "defective" than before? And if the latter, could this be reversed and/or trend the other way at some point?
Absolutely I agree, no point in criticizing people for making bad choices. People make the best choices they're capable of with the ingredients they have at any given time. Adults do have some responsibility for learning what better choices might be out there for them to make, but that also asks people to learn things that society as a whole doesn't necessarily provide much support or modeling for (speaking for this particular society I live in where instant gratification, empty striving, and emotional displacement are avidly promoted). We can't lay all the responsibility at the feet of individuals, even adult ones.
We could do a survey of people's grandparents in terms of functioning. My grandparents on one side: alcoholic, OCD, depression, sexual abuse, successful farmers, very smart children who became professionals. My grandparents on the other side: very ambitious, high-functioning, professional, also alcoholic, depressive, anxious, and sexual abuse. Also domestic violence, both sides. No "serious" mental illness (ie, bipolar or schizophrenia, no suicides), everyone had jobs and raised kids and appeared to be functioning to the outside world. Totally f*cked up otherwise, leaving trail of intergenerational crud. Also many good things.
It seems to me people are headed towards somewhat more emotional intelligence and willingness to talk about difficult things rather than just drinking or raging to avoid them across the generations I've witnessed, but I could be totally wrong.
In my experience everyone has always been broken forever, the old much worse than the young (with the exception of a small band of folks who had the misfortune to come of age at exactly the same time as Facebook, see Jonathan Haidt).
But I do think expectations are higher. Young people expect (or at least hope) to achieve some level of happiness, personal freedom, romantic success with a partner they truly care for, career success with some level of progression, fulfilling hobbies, a good social life, a white picket fence, kids, a dog, for people likely to go to therapy a college-level education, financial stability, the list goes on and on.
Meanwhile our Depression-era grandparents and great-grandparents considered hotdogs to go into the beans a special treat. The further back you go the lower the expectations.
In many ways the younger generations get the worst of both worlds, as they actually do have a lower standard of living than their parents (arguably at least). So not only do they assume they can and should have it all, the influential adults in their lives do too - and are disappointed when they don't.
People are, indeed, broken - self-awareness is a curse for the self-aware animal.
I think traditions and religion were load-bearing in a way that's not obvious at a casual glance, and we threw out the baby with the bathwater when we went full speed into modernity. A new, resilient psychological/social frame will establish itself at some point, but it might take centuries. In the meantime we all suffer.
I wish there were more alternatives to therapy, because it does seem like a gamble that I would be able to correctly identify the source of my problems, and then communicate it, to someone who will then give me useful suggestions I can implement.
I wish instead of therapy, I could pay to just be in the company of folks who know how to relate to others in ways I didn't have modeled for me. People who were raised in difficult environments can probably relearn a lot just from observing other people, but if they picked up difficult behaviors or self-loathing attitudes, it can be hard to get invited to parties.
It seems to me there are some alternatives anyway. Self-help groups, meditation classes, yoga, massage, acupuncture, church, knitting circles, bird watching groups, hiking adventures, workbooks, art classes, mental health apps, philosophy books, journaling, relationship workshops, psychedelics, antidepressants, breathing exercises, herbs, world travel, training for a marathon, falling in love, gardening, changing careers or locations. I mean, it depends what concern one is looking to address, but lots and lots of people solve the kinds of concerns people bring to therapy in all kinds of other ways.
When people come to therapy, they almost never have correctly identified the source of their problems. The only thing a person needs to come to therapy with is some provisional description of how they are suffering and a desire to alleviate the suffering. The rest of it is figured out in real time.
There’s definitely been a recent emergence of a sort of “mental health industrial complex” that has become bloated and as a result needs as many people as possible going to therapy to justify its own existence. I say this because social work and mental health counseling have over time become some of the most popular and least rigorous programs at universities in the US. As a result these programs are churning out licensed therapists who partied their way through undergrad + masters programs (the few I know personally literally faked their thesis and graduated with honors) and thus are unequipped with the either wisdom or expertise necessary to help people navigate the nuances of their psyche. I went through multiple young therapists offered through my insurance and was sorely disappointed that they really brought nothing to the table outside of repeating cliches that could be found on a “mental health” tik tok page run by a 16 year old. I was a “functioning” addict and even had one therapist suggest I should keep using my drug of choice if it helped with my “anxiety.”
Unfortunately, it wasn’t until I left the insurance system and paid top dollar for a therapist with 20+ years of experience that I was finally able to see the benefits. She had seen it all and knew a ton about the nuances of addiction, ADHD, and the ways it manifests in different people. She was brutally honest with me at all times and I credit her with helping me get sober.
So yeah, I think the point here is that being a good therapist is difficult and takes a lot of experience and knowledge. Humans are complicated. Unfortunately there’s at least as many bad therapists as there are good ones, if my experience is any indication.
It's true, the training in the U.S. now is mostly terrible in the standard grad programs and most therapists' actual training happens once they start practicing, hopefully to start with under the supervision of someone senior and solid. I think grad programs are completely confused about what they're teaching and the standardized accreditation has required programs to focus on checking off a long list of superficial "competencies" rather than training in deep skills.
For all of the buzz “mental health” gets in the popular press and the way people say it should be treated as seriously as “physical health” (something I generally agree with), you think we’d also be in demanding greater rigor and oversight of mental health professionals.
I didn’t want to get into this in my original comment, but a good portion of therapists coming out right now are MSW’s. A good portion of their curriculum is learning to look at the world through the lens of leftist identity politics. For many their approach to therapy starts and ends there. If you’re black and see one of these therapists, your depression is obviously because the world is racist and you have racial trauma. For me (white guy) it was because of “toxic masculinity”. Looking at the world this way is pretty much guaranteed to make your mental health worse, it’s like the anti CBT.
I avoid therapy like the plague for this reason. I expect my therapist to either believe in an ideology I don't share, or just be unable to empathize with my viewpoint - they work using soft skills with people, their social bubble is doing the same, and they're either a woman or a way older man.
Meanwhile I'm a relatively young STEM nerd and I feel they have no points of reference to problems I'm facing, or the approaches I use.
Well I mean, in theory just because someone differs from you in their ideology doesn’t mean they couldn’t help you or empathize with your viewpoint. But I definitely understand your point here. I don’t think you should write off therapy all together because there are in fact real professionals doing great work, they’re just the minority.
If you look at my original comment, my journey ended with a therapist who had decades of experience. The training for therapists 30 years ago (while having its own flaws) wasn’t nearly as ideological in nature. Idk what her politics are but she’s definitely not “woke” and was really well versed on both the neuroscience and subjective aspects of human psyche. Perhaps you would benefit from someone like her, or perhaps not. I do think the people who could benefit from a *good* therapist is greater than the amount of people who go to therapy.
In terms of MB typology, all the IN types are common clients as well as therapists. Also, I know my practice is skewed this way, but high in conscientiousness, in terms of the Big Five. I assume openness to experience and agreeableness are to a certain extent necessary to get people in the door. I gather young men tend to skew E, low openness, low conscientiousness, and low agreeableness. For sure people who are high in neuroticism (the other of the big five traits) would make likely therapy clients.
But I have some clients who are the opposite of all these things who have had very successful outcomes in therapy, so it must be a different question who is most likely to go to therapy and who is mostly likely to have good outcomes.
My graduate school advisor did this. The computer system gave each client in the clinic a battery of tests, and each therapist in the clinic also was personality tested. The clients were then matched with a therapist who was most likely to be compatible with them on personality dimensions and based on what modalitites they were proficient in.
It's called Systematic Treatment Selection, Larry Beutler.
I've heard the meme and I understand that the title is a reference to that meme. But beyond them both referring to therapy I don't see how the title is related to the body of the post. T body of the post is also about how different people have different mental processes so therapy isn't helpful for a large portion of people given their mental processes. Ok I guess I see the relation.
I've talked intermittently with therapists (broadly defined) over the last 20 years. It was only rarely helpful, but the few times it was helpful it was life-changing. I'd put the usefulness of therapy in three categories:
1) The large majority is rubber-duck debugging. It's amazing how many problems can be solved by just explaining them--somehow, for very many people, just explaining them with no worry about "what will this person think of me?" is enough to shake the solution into useful focus.
2) The more-helpful minority is asking good questions. "I'm having a problem with X." OK, tell me about it. OK, how about Z--is that going well or is there also a problem there? Have you considered Y? Sometimes, answering the right question clears things up a lot--but realizing that's the right question to ask and answer isn't easy to do for yourself.
3) The life-changing one for me was a missing tool. I was a 23-year-old freshman in college, trying to adapt to a different culture and with a history that posed some mental challenges. I talked to the school nurse, and she gave me this advice: "When something is going on and you feel stressed, try to decide if you are stressed about this thing on its own, or if it reminds you of something else and your stress is driven by the thing it reminds you of." That's been an amazingly helpful framing.
I don’t think “therapy helped me realize x” means what it sounds like it means, especially in the context of very obvious things like “I can solve problems with my brain”. It’s not “I would have disagreed that x is true before therapy” or “I’d never heard x before”, but more “I intellectually knew x was true but hadn’t ever really thought about it or internalized it to the point of usefulness”.
An example could be x = “I don’t have to keep relationships that make me unhappy.”
If you’d asked me directly, do you have to keep relationships that make you unhappy? I’d have said no, but when evaluating a given relationship in my life, I might not have been even asking the question “does this make me happy?”, instead evaluating it on things like “what do I owe them?” and “how painful would it be to try to end this?” and would have ended up keeping friendships or family ties that made me miserable. Therapy might help me think about that question more explicitly and help me consciously agree that it’s important and something I should value highly - it’s an explicit value realignment that you can clearly remember doing and reference in the future.
(For more example taken at a cultural rather than individual level, a thing the west coast has internalized that the east coast has not is “my happiness is important”, while the west coast could use a healthy dose of “some things are more important than convenience”)
I 100% agree with this take - it's very easy to know something but not apply that knowledge because you're using the wrong filters. You may be rationalizing, may be in denial, or you may just not identify a problem as the kind of problem to which obvious solution X applies.
This is one place where the rationalism project really falls down for me tbh: It's very good at figuring out how to make already existing frames of thought better ("Oh, I thought it was unlikely that a pandemic would occur but actually recent news makes me think it's more likely.") But that kind of thinking, at least for me, leads to focus narrowing. And all the smart things I've done in my life, whether making major life decisions or solving small problems have been done not by carefully weighing all evidence in a frame I'd already created, but by applying obvious, common sense solutions to a problem they did not obviously apply to.
Talk therapists have the invaluable tool of perceived authority. Like a hypnotist, this gives them the power to mold the thought process of their suggestable patients.
For example, IMHO, there seems to be two major (and opposite) tactics to make neurotic people feel better about themselves. Either, tell them: (A) "You don't need to feel bad, because you are a person with agency who has the power to control your feelings and actions. So be optimistic and empowered and change the things you need to change." Or tell them: (B) "You don't need to feel bad, because you are a person who has no agency due to a psychological condition that prevents you from controlling your feelings and actions. So just resign yourself to accept who you are and don't beat yourself up about not being a better or different person."
A good, intuitive therapist can figure out which approach will work with which patient and use their authority to get the patient to buy it. There are no doubt lots of other ways to "trick" people into thinking differently for their own mental health. Your friend or neighbor won't have the authority to get you to do so, however. Investing a lot of time and money to talk with a scientifically certified "expert" is probably the entry price of establishing the patient's "buy in" to the advice.
OTOH, talking to yourself should be fundamentally different from talking to anyone else and thus not quite comparable. If all you do for problem solving is talking to yourself, you can never get a fresh perspective on your problems, and at worst you get into an emotional feedback loop that has no outside corrective - youre going in circles.
OTOH, there is such a thing as rubber ducky debugging. You have a seemingly unsolvable problem, and you explain the problem in detail to a rubber ducky - either a literal rubber ducky or other inanimate object, or a figurative one such as a passively listening coworker/therapist. As you explain the problem, more often than not the solution will just pop up in your head despite you having received no pertinent input from outside. The solution was the problem analysis we made along the way.
Personally, I could vouch for either being true as Ive experienced both. So are they independent of each other, not mutually incompatible as they might seem? Are they true to begin with?
I've definitely experienced both. I have a constant inner monologue, I get into emotional feedback loops that take me in circles, and lately I've made a conscious effort to use something like the rubber ducky approach (without an actual object), where I question my inner monologue, playing devil's advocate in whatever way occurs to me. How could this be looked at differently, how would so-and-so I respect approach this issue? That helps to a certain extent. I've talked myself out of doing stupid things, figured out ways to solve problems, and have gained a better understanding of how I tick. It also helps, though, that I have supportive family that I can bounce my musings off of and get their perspective.
When people ask how to pray, I often hear the advice that you should always pray out loud. The reason given is that if you pray in your head it's indistinct. You don't actually have to take those thoughts and put them into the physical form of an audible sentence. By praying aloud you make your thoughts, feelings, and desires objective and observable to yourself. I think the same is true of what you describe. If you're talking about a problem to yourself in your head you can let all sorts of details fall by the wayside. You don't need to think every word exactly as you would if you were talking to someone: words and concepts get mushed together in your mind, and you often make assumptions without thinking about it because the gaps in your logic are papered over. It's like imagining a house you want to build vs actually building it: if something in your mind isn't actually stable you won't find out by thinking about it over and over. Instead you'll realize your mistake when the house you're trying to build keeps falling down.
Years of therapy and also married to one. Here’s my take: rich people can afford better therapists. Psychologists who take insurance are either new to the profession, or not terribly effective and need the network to get new clients. Which is to say, if you have the money and the time, you might benefit from individual therapy. (Basically the worried well, sancerre crowd.) Cheaper and far more effective are therapy groups which help create accountability and community.
Boy was this a timely post for me. Just today I got off the phone with a social worker where I'd discussed my new job and my concerns about how long I'll be able to keep it. I've been struggling with issues of productivity in my personal and professional life and I'm considering therapy as a result. I've always thought of therapy like medicine, you take it when there is something wrong, but unless you have a "chronic" condition that will never go away, a healthy person should be able to function without it.
Therapists have nothing on receptionists. I have over 15 years of front desk staff experience, mostly acquired while getting a PhD in something else. It's crazy what people will tell you about themselves when they realize you're a captive audience. Not only that - they come back regularly. Twice a week sometimes. And often they repeat the same stories about their lives, over and over. For years I felt bad for these people and thought they just needed a listening ear, so my personal policy was to give it to them. But then weird things started happening.
A word to the wise, if you're thinking of getting free therapy from a receptionist: Don't pick a receptionist at a place where you work/study/live or otherwise hang out regularly. Receptionists know, see, and hear EVERYTHING, including things about other people that you may be talking about in your free therapy sessions. In two different cases, I had "regulars" who were around the place so often that I could watch how they interacted with others in real settings. Each of them was consistently misinterpreting reality in different ways. Person X was absolutely convinced that Person A was madly in love with them, when they clearly weren't, and Person Y was absolutely convinced that Person B was out to get them, when they clearly weren't. Again, two different people, each of them giving me weekly reports on situations that - as I could see for myself - were just persistent misinterpretations. No doubt a real therapist would say something interesting here about how misinterpretations arise from projections of desires or fears or the id or what you had for lunch; I don't know anything about that. I just know that these two people were clearly wrong about the things they were agonizing about.
(This shook my faith in the therapy profession as a whole. Assume most therapists don't have the advantage of being receptionists and thus actually knowing about the real settings their clients are in. They depend totally on the client to describe reality. And if the client is way off base, the therapist won't know. How is a therapist supposed to help someone if they're not even in a position to say "You're completely wrong"?)
Actually, I may have an answer to that last question. Eventually I decided to gently push back on Person X and Person Y. REALLY gently, I thought. When Person B asked if cheese were around, was it unquestionably a reference to a conversation three days before when Person Y complained about the shared fridge? I asked a couple questions like that. Then I got the reactions: defensiveness, vehement repetition of the original story, signs of distress. In both cases I was so surprised I backed off, immediately. Things toned down and we wrapped up our usual session pleasantly. But then Person X completely stopped coming to see me, and Person Y took a break for several months.
Was it a good idea to try to help these people by disillusioning them? I don't know. But maybe it's a good strategy for (not-too-awkwardly) decreasing the number of people who come to you for free therapy!
You can learn a lot about a person by how they respond if you push gently at their defenses. We learn all kinds of extraordinarily polite and gentle ways to do this as therapists in a context where we have more explicit permission from the client to do it, so they don't so often walk away, but we do see deflection, distress, vehement repetition, just as you did.
Because therapy is a relationship that plays out in real time also, people tend to manifest the stuff that hangs them up out there in the world also in sessions. But also over time you hear clients describe situations they get in with multiple other people and you hear them describe their perceptions to you and it pretty quickly forms a picture of where the tangles are.
Therapists spend a lot of time with a lot of different kinds of people, listening to an incredible volume of material, and it really does give a person a kind of unique angle on humanity. You start to see patterns that you'd never otherwise get to see. It sounds like you got some of that in your role as well. Of course it's dangerous to assume we have it right, but we also have ways of testing hypotheses and the client will bring back evidence of whether we were right or wrong based on how they handled something out in the real world. And then I can get a sense over years and across many people about how often I'm right and how often people surprise me and that helps me calibrate my confidence.
If people's main difficulty is interpersonal, we also get a lot of first-hand evidence to look at in the form of texts, emails, and relayed conversations that the client shares. Even when you ask someone, "and what did they say when you said that to them?", it tells you something about what interpersonal situations are like for them.
Also when you ask "have you tried this?" or "what do you think would happen if you said this?" -- their responses to those kinds of questions gives glimpses into how their inner world is structured in a way that's pretty hard to hide (if the client is not actively pretending to be other than they are, which would be a big waste of their time and money). When someone says, "oh I could never say that" and you start to inquire about the why of that, it gives still more picture.
Couple's counselors often love that they do get to engage in real time, both to see first-hand where people get hung up and to be able to help repair it right in that moment. But it's not essential to do it that way by any means.
Thanks, Radar! This peek inside the profession is super interesting. I wish I'd known more of your "extraordinarily polite and gentle ways" during my receptionist days. After leaving front desk work I did wonder whether I shouldn't have actually talked to a therapist just to get some advice. Some people seemed to benefit from simply having a listening ear on occasion. But others had hang-ups that were beyond me, as I found out! I also began to suspect that Person X and Person Y really didn't want help as much as validation, and I got increasingly uncomfortable with that. I'm glad that real therapists do have ways of figuring this out, even without the benefit of sitting at a reception desk!
It took me going to therapy at the age of 24 (and the mindfulness practice the stemmed from it) to realize that I'd spent the last decade of my life completely dissociated from my body. I'd lost almost all sense of interoception and emotional awareness beyond the most gross of emotions and sensations.
Yes, traditional therapy is often just "talking with someone", but it is *not* just "talking with anyone" (although this in itself is something that would be healing for a surprising number of cripplingly lonely people). It's talking with a "someone" that is trained in helping you process and integrate all your shit, and the difference between that and just talking with your average untrained person is very often life-altering.
And this is just the traditional psychoanalytic model, not to mention the huge variety of embodied and trauma therapies that do far more than just "talking"
I had a similar take to Qiaochu after reading the Sequences. I'd emphasize "solving MY problems," because school/college just teaches you how to solve "the problems" that are handed to you. And when you're surrounded by people in an identical situation to you, you don't even need to solve “it’s cold outside,” because that's already covered by "dress like everyone dresses," a subset of "blend in with your perfectly homogenous peer group."
Rationality woke me up to the fact that actually there are problems that only I have, or problems that only I can identify, and I have the ability to both name them and apply myself to solving them, and if I don't then maybe no one else will, and there are $100 bills lying around everywhere, etc.
So that's why his take makes sense to me, even though we both probably appeared to have plenty of agency before we experienced those psychological changes.
I don’t know that this post delivered on it title (though I enjoyed reading it): Men Will Literally Have Completely Different Mental Processes Instead Of Going To Therapy
Was thinking maybe this was going to be more about why you therapy has evolved to favor techniques that work better for women than for men?
I think it's parodying a meme in which people say men will literally do X rather than go to therapy. But it sounds like the reference isn't as well-known as Scott thought, judging by the number of commenters who don't recognise it.
There's nothing wrong with some niche humour, but I'd urge people to add explanatory notes for a wider audience. (I wonder if the 'Know Your Meme' website explains this one.)
In this case, the niche is 'being very online' (perhaps especially on Twitter). I wouldn't want to promote the idea that this is a good thing, and that people outside of it are missing out.
The first time I saw a professional therapist as an adult I was maybe 22. Which is almost exactly 20 years ago. I feel like the trend has become less male-friendly, but I encourage male friends to see therapists regardless. You have to try harder to find someone that won’t tell you all of your problems are because you’re male, but once you do your chances of having success with a therapist are pretty good.
Also being in therapy ourselves helps us separate our stuff from our clients' stuff which is important to doing the job well.
It used to be a requirement of most grad programs that therapist trainees be in their own therapy (different from clinical supervision) but that requirement has been abandoned so that you can't assume anymore that therapists have ever sat in the client chair.
I personally wouldn't trust a therapist who hasn't done their own therapy. It can create the sense in the therapist that therapy is for other kinds of people. I can't for the life of me imagine what motivations would sustain a therapist in this rather demanding and ambiguous career if they hadn't themselves experienced substantial benefit from therapy.
I spent a few years volunteering online on an emotional support site, and was quite popular with people coming back all the time and swearing how helpful it was, even though it was basically just active listening: empathizing, summarizing, asking questions without a hint of judgment. And yet when I tried to have someone listen to me, there was zero benefit. I felt nothing of what I preached to other "active listeners" that the person on the other end would experience. My now wife whom I met there was wildly more successful and popular, and, years later, is still being remembered and missed, and the guides she wrote are still in use. And yet she did not benefit from being listened to, either. Well, until she talked to me, I suppose, since she kept coming back, though not without an ulterior motive. But still, it is very much possible to help people quite successfully by just chatting with them, without ever feeling helped while being on the other end of such a chat.
So yeah, I fully developed the sense that "therapy is for other kinds of people".
I tried a professional therapist once or twice, and while it was a bit of a relief to vent there, and maybe get some advice on basic relaxation techniques, the experience was basically the same: therapy is for other people.
Incidentally, I had the same experience with hypnosis: I have been able to put willing subjects into trance pretty quickly and reliably, but was never able to go there even with a professional hypnotist. Which is kind of sad, I'd love to experience that feeling.
It makes sense to me a person might decide that therapy is not for them. It doesn't make sense to me that that person would choose therapy as a career therefore.
Hmm, I felt a profound satisfaction from helping others. If I did not already have a career, I would have seriously considered spending a couple of years getting the credentials required to do it professionally as a clinical counselor. But who knows, if push came to shove, maybe I wouldn't have.
On a kind of related subject, I am a teacher whose style of teaching seems quite effective, I usually have very positive reviews from the students, but when I go to a training course I hate to be taught in the style that I am using.
To me the reason to go to therapy semi regularly (in addition to reasons posted here) is simply that I've had a history of sudden depressive episodes, and maintaining the relationship means that if that occurs I will not need to start "from scratch" as I have in the past. Of course, this mindset and discipline means I'm unlikely to have an episode like that but sometimes tautologies emerge from this kind of process.
It seems extremely likely that most if not almost all people can, in principle, benefit from talking things over with someone else. Why not? We're a very social species -- it's no accident we have this incredibly sophisticated apparatus for communication -- and we would probably all agree *harm* can be done by having the wrong kind of conversations with the wrong person, so why not good done by having the right kind of conversation with the right person?
But what I would say is the $25,000 Crocodile Dundee[1] question for a lot of people is: would the chances of a positive outcome be substantially improved if I talked to a professional, instead of to my friends, a 1-800 phone pr0n number, Eliza, random trolls on the Internet? Is it possible in principle to train someone to do significantly more good than average when talking things over with troubled people, and does it actually happen in practice?
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[1] Because in the eponymous movie the Croc when told about a NYC woman who was going to therapy to talk about her problems responded in surprise 'Hasn't she got any friends?'
Is there a type of therapy that just consists of working through a remedial education on every micro-soft-skill you could potentially be missing? I wonder how effective it would be if given to the people looking for the more regular types of therapy.
I quote as appetizer: " IV. Peterson works as a clinical psychologist. (...) Much of what I think I got from this book was psychotherapy advice; I would have killed to have Peterson as a teacher during residency. (...) Jordan Peterson’s superpower is saying cliches and having them sound meaningful. There are times – like when I have a desperate and grieving patient in front of me – that I would give almost anything for this talent. (...)
So how does Jordan Peterson, the only person in the world who can say our social truisms and get a genuine reaction with them, do psychotherapy?
He mostly just listens: (...) -end of quote - now you get to that link and read up! :) btw: was the first text I ever read of SSC/Scott, following a quote I found somewhere - a lucky day, if ever there was one
There is a huge skill gap between the median software developer and someone in the top 1 percent. I expect the gap among therapists to be even larger because brains are more complex than computers and don't give as much clear and immediate feedback. So I don't think it's just the patient but also the therapist who determines how effective therapy is.
Therapists aren't really trying to understand brains though. Lord knows psychological therapy wouldn't exist if it depended on therapists knowing what firing pattern of her 80 billion neurons was specifically responsible for Stacy's feelings of inadequacy and knowing how to directly manipulate said neurons through conversation.
As a retired CB therapist my experience was like yours that about 50% of my clients would achieve a satisfactory outcome. There is a movement within my former profession that the relationship is everything, but I note that the average rate of success still remains around 40% for therapy outcomes.
My client's feedback was pretty consistent. They thought I gave hard love. Tough, but practical. Those that said that did well. My other clients often complained and wanted a different therapist. They didn't do well with me.
Unlike my more touchy-feely colleagues, I was happy enough with this, because as my Isaac Marks said, the therapeutic relationship is not sufficient unto itself to effect change. Have being first taught under Prof Marks I tend to concur.
That's not the current flavour of the month for evidence based medicine in Britain, or anywhere else AFAIK, especially with programs to teach people scripts tailored to specific client problems by using actors for example. I understand that good results were achieved, and using unemployed actors is cost effective, but my intuition tells me that if this is so, then what is it that makes cognitive behavioural functional analysis useful if it can be delivered by rote?
It nags me that that therapy can be reduced to scripts, because while I have script routines/approaches to client problems, I also make use of my ability to think outside the box too. Maybe I'm just deluded about that.
With regards to what is often called the worried well; those people with the need to seek reassurance from health professionals, my answer would be blunt. Reassurance doesn't work, because if it did then the clients wouldn't keep returning for reassurance.
Sorry, not sorry, but as you may have guessed my training emphasized behavioural modification, though I also took a lot of course with Padesky, so not a purist about this.
Though it sounds like a cop-out, having worked in the metal health sphere for a while now it does seem like the primary predictor of outcomes is if the client wants to change. Certainly some people do want to change but have a bad therapist, but is more common that someone is willing to try therapy but not willing to change anything about themselves, even just their perceptions of themselves. And if someone doesn't want to change there is nothing you can do to change them. There's a level of humility required to get a lot out of therapy. You have to follow Peterson's Rule 9: "Assume That The Person You Are Listening To Might Know Something You Don’t". That can be a hard step for people! It was certainly hard for me. There's a lot of pride that can be a major obstacle: the kind of pride that prevents you from taking what other people have to say seriously if they're telling you something you don't want to hear.
This is a good illustration of why progress in mental health is so much harder than progress in physical health. If a medicine kills a virus, it will kill the virus, whether the patient wants it to or not. If you want change someone's outlook on life, they have to work with you or it won't work at all.
Also sometimes you have one little problem that you assume means you are irremediably broken, until someone comes along IRL or in a random internet forum and you realize everyone else got it. I have a friend who thought she was a horrible person for having intrusive thoughts until I reassured her that it was normal and something everyone had. I also heard a first hand story about a girl who thought she was dying until someone told her that periods were a thing. And there are phenomenons of rural families where no one ever goes to college, until one person does and suddenly half their cousins start to want a higher education too. Maybe sometimes you just need reassurance that everything will be okay.
This seems like a clear case of one man's medicine being another man's poison.
Can it be that people with a reduced capacity or habit of introspection can benefit immensely from outsourcing the job via therapy, while people already living too much in their heads, already too stuck in their own mental loops or even already too self-absorbed can actually be hurt by therapy (or become *pathologically* self-centered and narcissistic and unable to see anything beyond themselves, as I have seen firsthand), and in these cases of the already excessively self-reflected, "men will literally go outside and fix motorcycles instead of going to therapy" is 100% the right thing to do.
I think an important factor in the variance of therapy outcomes is that many (most?) therapists are bad.
I got, I think, what many people describe getting from therapy, from joining a discord server full of like-minded people that happened to contain a decent number who were older than me, and had been trial-and-erroring psych solutions longer than me, and could offer guidance about what to maybe trial first to get good results faster.
I had seen four therapists and two psychiatrists before joining that server, and all of them rank in benefit to my life below that discord server, my countertop dishwasher, and my toothbrush. Some of them were outright negative in benefit by themselves, most of them were absolutely negative when the costs in time and money are factored in.
I personally attribute most of this to the ableism inherent to the therapist selection process. The skills needed to become a credentialed psych professional are exactly the kinds of things I was up against a wall about, and every single one of them reacted to my problems as if it was impossible for anyone to have the struggles I was having, they did not appear to have any of the problem-solving thought-skills you describe, and could at best offer the empty encouragement that it was obvious I was easily capable of the things I had just described struggling with. One of them said, verbatim “will it really sounds like all of your problems are psychological” and that was, the END, of their insight. All they had to offer. Nice people, empty heads.
Interesting that you write your perception of therapists is they're high functioning. Here in Eastern Europe, the (accurate) stereotype is that people become therapists as an outgrowth of becoming interested in psychology to deal with their own issues, of which they have an above average load. One way I heard it put is that therapists are people who need a psychiatrist.
Necessary context is that the professions are strictly divided here, so a therapist is a person you talk to, and a psychiatrist is an actual doctor who can prescribe medication. Not sure how it is in the US
Also possible that it is possible to be high functioning relative to me (at, specifically, careerish stuff.) while being low-functioning relative to other professional types.
It is also divided here, and credentials are not even strictly necessary to label oneself a therapist in a lot of places. but all of the ones I tried had at least college degrees. (in my area, the other options all involve crystals or Christ)
Crystals have been making their way into the offices of even college-educated therapists here.
On the autism-schizotypy spectrum, the people who self-select to be therapists are definitionally susceptible to astrology, crystals, Jungian woo woo and all the gamut of overmentalistic cognition, so this is not surprising. The interesting question is how a healthcare system may protect against that, given that it tends to go hand in hand. Otherwise, we'll end up with literal shamans.
Here, you can't be a therapist without a college degree, but people circumvent the licensing requirements by just calling themselves "coaches" or whatever. Obviously, those are even worse, but even the college educated therapists usually need a psychiatrist.
I dont doubt that there are some areas in my life that could benefit from me hearing something pretty basic. But what I do doubt is whether I would be willing to listen to someone telling me one of these basic pieces of advice. I think often once I'm ready to hear it I will also come up with it pretty soon myself anyway.
Yeah, I never even understood the basic idea behind therapy — if thinking about my problems could help, it'd have done so long before I went to therapy.
I went a few times just to see — well, more because everyone kept telling me to try it — and yep, it was exactly as useless as I expected. The problems and solutions were obvious: it was my willpower and emotional state that stood in the way, and no words or thoughts could change them.
One of the things people 100 years from now will consider our embarassing blind spots is how we call "thymic health" issues that are fundamentally about hormones and metabolism "mental health" issues. The mind is where a bunch of the more noticeable symptoms manifest, but it certainly isn't where the problem is, nor where cures can be applied.
I remember seeing a therapist and always feeling bad when I left. Then getting through my week to go back. It seemed like a goal I was not moving forward with except I was running out of weeks until the end of therapy. With feeling so bad, I decided NOT talking to a therapist felt better. I found an online group beneficial. That way I could write at any time of day or night. I found the typing itself got out the energy and bad feelings. And reading about many others with similar, or worse, situations helped too. All on my own schedule and when I needed it.
Also, even if you know how to do the required introspection yourself, paying for a therapist is committing future-you to actually putting in the time to do the work.
It’s like going to the gym (or maybe paying for a personal trainer) vs. just working out at home; many find it’s much easier to blow off the latter, even with the best of pre-registered intentions.
I hesitate to mention this, because in the video the analogy is from, the idea that's being compared is specifically political, and I think it under-credits more thoughtful people from the side of the political spectrum who are being criticized. But, well, there's this video, "I Hate Mondays", which is basically explaining that a move that gets used in politics, to avoid engaging with uncomfortable thoughts about a problem, is to treat the problem as if it were something inevitable -- as long as you have a day or two of rest, the day when you go back to work will always be a bit of a drag. You could change exactly which day that is, but work has to get done _some_ time, and so well, Mondays, whatchagonnado? We can gripe about them, but that doesn't mean we should try to change anything.
The criticism is that people often sweep problems into this category -- things that you can gripe about, or in some cases even sincerely feel sad about, while still considering it a waste of time to try to _do_ anything about them -- even when there are actually things that _could_ be done, because those things discomfit them. The video poses this as being a common pathology of conservatives, but one might just as well look at liberals whose mental processes go skating away from policies that might address homelessness when those involve deregulation, or reforming California's notoriously terrible CEQA. One of our local Sierra Club chapters has recently taken up a position _against_ streamlining CEQA review for bike lanes and sidewalks. Clearly the best way to protect the environment is to make it prohibitively expensive to facilitate non-car modes of transit. We must protect The Process. I'm sure that endangered wildlife will find a welcoming home in the thickets of paperwork. /headdesk
In any case, to circle back to the point: I think what your friend was saying, when he said it hadn't occurred to him that he could reason about his problems and then solve them, is that he had been trained to make this move almost reflexively, about anything bad. Thinking about bad stuff is uncomfortable. So just tolerate it, be stoic about it. You can't _do_ anything about bad stuff anyways, trying to just means spending more time with your mind in a state of discomfort.
I think you’re on to something. I’m not sure if people do the sweeping because it’s uncomfortable to consider solutions or engage in change. But I think there’s a deep loyalty for some people to a concept of personality as inviolable or as something to be accepted and carried rather than altered. Framing an interpersonal situation as a problem to be solved was utterly out of bounds for some people (even recently, 1980s).
I am not sure if the current framing habits are actually any good. I’ve had a range of therapy experiences. I was totally unable to put certain things into words for years. Talk therapy didn’t address those issues. I still resist considering myself in psychology terms; some of it is close enough to be interesting, some of it is just kind of made up as far as I can tell. So I sympathize with the writer who found themselves realizing they had a personality. There’s a framework there and if you can get on board with it you can experience help from the helpers, or “reason” about and “solve” some personal problems.
I spent all day trying to find a phrasing for this and I didn’t really. “Shared third eye” was as close as I could get. There is a way people can get on the same wavelength and thoughts and concepts become visible in conversation in an almost tangible way. As screens proliferate I think humans are losing that skill - not permanently, but just not knowing it’s a thing. It requires a type of mutual attention. Feeling a shared intimacy of personhood really changes one’s ability to see oneself as an atomized operator and analyze and choose individual actions to attain individual results. I think some of the unfamiliarity is the transition of society from the shared to the atomized.
As someone who went to graduate school to be trained as a therapist, I was planning to jump in to offer some alternative takes on therapy as a profession - both how it is more than supportive therapy/talk therapy as well as the trends/flaws/susceptibilities within the industry that have contributed to many individuals' negative outcomes - but Radar has already covered the subject eloquently and likely far better than I would, especially since they've got real-world experience backing it and I segued into higher education afterwards. Instead, then, I'll offer a metaphor for how I always viewed supportive therapy specifically.
I would equate supportive therapy to getting dressed in front of a mirror with someone else giving their opinion on your outfit. Some people have an innate (or have developed over time) a sense of fashion and are aware of their own personal tastes and can get dressed just fine without a mirror or any outside assistance. Some people have a good sense of what they like but also want to double-check themselves, and so can get by on their own as long as they have a mirror to take a look at themselves and double-check their outfit before going out. Others (whether because they haven't developed a personal sense of fashion or style or are just seeking some outside validation to make sure they're in step with their local groups/social circles) like to have a third party offer their advice on what is working with the outfit, what isn't, and offer suggestions or changes as necessary.
I think that goes a long way towards explaining the variance in the efficacy of supportive therapy! How much bang you'll get for your buck depends on how much you have access to an empathetic ear outside of therapy, your ability to self-reflect, your own strategies and methods for processing your feelings and the various day-to-day events of your life, and how capable your third party is in helping your evaluate (or re-evaluate) the approach you're currently taking. It's definitely not necessary for everyone, and the industry is definitely saddled with its share of individuals who are doing more harm than good (whether properly credentialed or not), but I don't think the variance is all that mysterious.
A difference I found in therapy is: when talking with friends and loved ones about sources of conflict, hardship, whatever, I frame it in a way that is attempting to garner sympathy. When talking to a therapist, I frame it in a way that is attempting to be constructive and resolve the issue. Sometimes just framing things in that new way caused me to realize I had methods to deal with these issues already, but wasn't consistently applying them.
In my own experience therapy is really helpful to time-bound lines of thought that otherwise become dysfunctional.
For instance if late at night i start falling into a depressive thoughts rabbit hole in which I question all of my life choices I can defer thinking those thoughts to the next session.
I also have a relative has a really bad addiction and has consistently harmful interactions with me, and i can cope as long as I can vent my frustration with someone, but I don't want to berate my friends thrice a week telling them how a person they don't even know has found a new way to get at me.
I don't go to therapy to be given advice (clearly), nor do I go for reassurance. I simply enjoy and benefit from setting aside an hour and having someone help me organize my thoughts; I'm paying for time outside my own head. I can't do this with a friend because they're too quick to try to advise, or to be indifferent. The therapist remains objective yet engaged at the same time. It's moderately helpful.
I would definitely benefit from talking to someone about my issues in order to think through them more clearly. I have inner monologue but there's some ugh field around some of my issues; and also having to explain stuff to another person can help when I'm stuck even when there's no ugh-field (https://en.wikipedia.org/wiki/Rubber_duck_debugging).
But this requires me feeling that the person I'm talking to cares, is interested, actually follows, and is open and not trying to fit into a model of a healthy mind. The couple of times I tried therapy, this didn't happen. I find the relationship with the therapist unnatural, unclear, uncomfortable. I don't know to what extent I am supposed to give in to their expertise and "treatment" and evaluate the results months later, or treat them like paid professionals that I can use to help myself by taking the lead.
It is important that the therapist care, be interested, pay close attention, and is not just trying to jam you into some box of "normal" or any other kind of box. It is important that you like the therapist genuinely and that you hang in there long enough to trust them enough to care what they think and to respect them.
The relationship is somewhat unique in all of society and so it can feel uncertain and unclear at the beginning -- "what are we doing here?" and "how do we do this?" Those are questions you get to talk about with the therapist.
I would say there is no need to "give in" to their authority. It is a collaboration where you have room to get clearer and clearer about your goals and the therapist helps map out options for moving towards those goals and then you try various things out (in session and in-between sessions) and you bring that evidence back and explore it some more to see what helps and what doesn't help.
I do think it's rare for people with long-standing issues to experience huge change in just a few sessions and so often you do need to be willing to commit to trying it out for a few months before rendering a judgment about whether it's overall doing what you need it to. But also, one should have the sense early on -- within the first three or four sessions -- that it's helping at all. The first one to three sessions is a lot of gathering background, but by the end of the third session or start of the fourth session (and often sooner), one should have the feeling that this seems like a helpful thing.
Different people are able to take the lead in sessions more or less depending on who they are. Therapists often like clients who can take the lead because it's easier for us when people know what they want and where they want to go, but it's also not essential. Even if you are able to take the lead, it's still a collaboration, a conversation between two people. Sometimes people treat therapy like there's not another person in the room and they just unload and could have done that in an empty room. It's fine if that happens sometimes, but if a person finds themselves doing that in every session, they are missing an opportunity to learn (I know, I did that myself as a client for a long time).
My therapist (rogerian) is basically someone who I pay to listen to me. All they really do (except on one quite funny occasion) is basically paraphrase what I've said back to me. Over time this basically helps me narrow down themes, things I'm actually unclear on, things that I'm hiding from myself and others etc.
You can basically do this with journaling etc. But I don't trust myself to accurately reflect myself.
You can do this with anyone really, but friends and family are often the people I'm talking about so that's not really possible. Friends and family also have years of ideas about who I am that could get in the way.
My therapist is just a relatively neutral sounding board that helps me to uncover the layers of things obscuring the path forward. The quote unquote breakthrough I had was basically me slumping into therapy, flopping to the chair and being like "This is all the stuff I need to change, I've been hiding it by xyz, you have known this since our first session because its painfully obvious from the outside isn't it?" and them basically smiling and nodding.
For me, it's a combination of "you can't tickle yourself" and the old adage about how with prostitution, you're not paying for the sex as much as you're paying for the prostitute to leave afterwards.
You just can't call yourself out on your own bullshit as effectively as someone else can. Or, even if it is something you're already telling yourself, it can be helpful for someone external — who isn't meaningfully in your life — to back you up and help your homunculus lean on the right levers.
And there are certain things you can't or shouldn't put upon the important people in your life, at least not unfiltered. With therapy, you can just say the most unfiltered version of things without worrying about judgment or eroded relationships.
Lastly, I find couple's therapy really helpful in that difficult conversations can be moderated and steered back towards productivity, and it provides a sort of "disinterested third" who can provide accountability for partnership goals.
Someone else brought up priests, here, and I find that really interesting because I do think that therapists can be like secular priests, and this could be a good or bad comparison, but I take it as a negative...
you could say that a priest's job is to selflessly help his parishoners, but more often than not you can find examples of priests abusing the power imbalance in some way, or using their position as a way just to rag against all the things they hate... rather than be a holy, good, nice 'man of ogd', like you might say the job description entails... because descriptions rarely capture how something plays out in the real world.
The same thing with therapists, but a different set of people might be fooled by the same behaviour that corrupt priests exhibit, but because it is not about 'religion', but instead framed as 'laws of psychology'...then different people might take it seriously.
A lot of people are more interested in dogma, than actually discovering more about the universe... and you might say 'honoring God', if they're priests...
The best the therapist I ever had was a psychiatrist who kept telling me how f**ked up my life was. Every session with him made me more depressed. Moreover it made me angry, because there were a lot of wonderful things that I had experienced, and he didn't seem to be acknowledging them (I just wanted advice about how to get through a particularly stressful time in my life). I finally lost my temper with him. I shouted at him, "My life isn't f**ked up!" He smiled at me indulgently and told me the session was over. I walked out angry, but in defense of my statement I kept thinking about all the cool and fun things that happened over my life (up to that point). Then I realized that my life was actually pretty good, and whatever problems I was having weren't that big. And I realized I didn't need his help. I never went back. To this day, I'm NOT SURE if he provoked me on purpose to get me out of my rut, or whether he really thought that I had messed up my life. Either way, once I started looking at my situation in positive light I never needed counseling again.
Peter D. Kramer in one of his bestsellers, forget which, talks about this one therapist who made a breakthrough with a patient who was having persistent slightly paranoid thoughts. Legions of therapists had tried to get the guy to look at the evidence clearly, in hopes he would see his suspicions were unfounded, or explored with him why he might be having these thoughts. Nothing worked. He' d become immediately defensive, dig in, et cetera.
So the guy is talking to our hero one day, and he wanders off into a slightly paranoid fantasy of what his co-workers meant when they said X or Y, and the therapist leans forward intently and says "Those bastards!" The patient is totally taken aback, and starts explaining why the *therapist* might be mistaken, and this is the beginning of real change. If I recall correctly, Kramer said this was an exceedingly risky strategy, but he admired its chutzpah and the fact that it actually worked.
I’m honestly shocked to be reading this from a rationalist and psychiatrist. Therapy provides patients the framework to think about mental health and the vocabulary to talk about it. It is the only chance many patients will ever have at reconciling the “why” behind their illness. I am curious why the rationalists on this substack would cite inconvenience or "just use a friend" as reasons to shy from the chance to test their mental constructs of the world by an objective party who will challenge their consistency/accuracy. Am I missing something? Why all the hate?
I'm a psychologist and I don't think therapy works very well. There are a number of reasons for this, but its not "hate."
1. We have several generations of people who are resistant to insight-oriented treatment, because cluster B personality traits are now so prevalent, they are almost normative.
2. Genetic expression accounts for a huge part of human behavior, and those people who develop personality and other psychopathology have behavior patterns that are almost impossible to dislodge. Other biological factors are in play as well.
3. Severe mental illness (psychotic and bipolar processes) get the biggest bang for the psychotropic buck, because they are totally organic issues. I have patients come to me who have pre-existing diagnoses like Bipolar I, who have been stable on meds for some time and I can't tell they are Bipolar.
4. Most therapists have no idea what they are doing. They read a book on some modality they like, and it is the hammer to everything they see that looks like a nail.
5. A person who walks into a therapists office with the attitude of "what is wrong with ME" is like a unicorn. I have never seen one. They all come in wanting to change everyone around them, which is not possible.
Thanks for your insight. #1 is of great interest to me, would you be able to explain what you mean by the increased prevalence and normalization of cluster B traits? I am very curious to see if there is actual data on this beyond anecdote. I have heard that classic NPD is resistant to therapy, but that some subsets of cluster B patients, such as those with with narcissistic "fleas," may actually derive a lot of benefit. Has this your experience in practice?
#4 is also intriguing and unfortunately makes a lot of sense. Can you please elaborate on which modalities are more/less effective? Wouldn't a therapist want to have multiple modalities in their tool belt?
I might suggest that -a- reason (not THE reason) for the popularity of "talk it out" therapy is the decrease in personal relationships.
I was in an isolated place and time in my life going through a divorce, and going to a therapist was helpful, just to unload a little. After about a year, the initial trauma was, well, scabbed over if not healed, and at some point I realised that continued progress would really depend on me making significant changes in myself and my life, and quit going.
I buy the idea of the therapy I had 2 years ago, during a severe bout of anxiety & depression, as unlearning a set of rules I had about myself & replacing them with more useful ones. There was nothing mysterious about it per se, although the therapist was remarkably good at treading the line between being a faux parent and a kind of dispassionate mental mechanic. My default state remains 70% actively happy, 20% neutral & 10% confused & anxious. Prior to this I was 70% confused, anxious & angry & 10% happy but waiting for happiness to dissipate. I doubt I could have got here without 2020’s 6 months of weekly Zooms with her.
Is it possible that therapy has very little effect and people are just believing that it does? For example, could it be possible that without therapy, QiaochuYuan would have been the same successful person, but would have nothing to attribute his success? A bit like billionaires who credit hard work for their money, while it's usually just luck?
Are there some studies that prove that therapy is *actually* effective?
For all therapy in general, no. For some specific therapies, definitely yes. The studies for Cognitive Behavioral therapy are starting to look pretty good, across a wide range of conditions.
In my practice, what I see (saw, I only do one-shot evals and court testimony now) is that the evidence-based treatments worked for a while, but they did not solve the underlying issue. 6-18 months later, the client would be back with the problem simply manifesting in some new maladaptive behavior. Psychodynamic therapies work, but to do them correctly takes years, sometimes multiple sessions per week. Insurance doesn't pay for that, because they want results in some set number of sessions.
...I'm really, really glad I live in a country where "what insurance will pay for" is not the benchmark. Although we have mental health funding issues of our own.
I went to group therapy and we had a new person introduced, who among other things had anger issues.
they would start arguing with their partner about something and in the end they'd black out and become violent, and wanted to do therapy to well, stop doing it.
I asked if they ever tried to just stop arguing and go for a walk until they calmed down when they felt they were becoming agitated, and they just looked at me like I said water was dry and the ground is lava.
they said that "not having arguments that lead to violence" had never, ever crossed their mind, and were flabbergasted at the mere thought of "just stop doing that bad thing that leads to even badder things".
I want to throw a big old culture clash into this discussion.
I've lived big, big chunks of my life alongside two groups: jewish academics, and old fashioned Chinese farmers who happened to become engineers during the cultural revolution.
The jewish academics can't get over the idea that the old fashioned Chinese farmers who happened to become engineers during the cultural revolution have precious little to no self analytical habits.
The old fashioned Chinese farmers who happened to become engineers during the cultural revolution can't *see* therapy, or self analysis, or a robust inner monologue. It all might as well be the seventh ultraviolet shade of purple, or the color greb.
I'm sorry if this ruffles anyone's feathers, and I welcome if someone wants to offer a different experience.
This really speaks to me. I've struggled with fairly severe depression my whole life, as well as anxiety and addiction. Due to the nature of my work I couldn't get therapy for a long time, but that recently changed and I started going. I've probably been in it about five years. I've tried about five therapists in that time, almost always giving them month's worth of time to give it a valid try.
Honestly, it didn't help. Pretty much at all. I blame myself. There's something about me, even when I have a realization it doesn't do anything to persistently change my mood.
It's so frustrating because I know *so many* people who talk about how much therapy helped them. Which really makes me wonder what's wrong with me.
The things that have helped in that time:
1. Cymbalta was amazing at first, then over the course of a year or two the efficacy went away.
2. TMS was amazing for a while as well, although its effects are waning recently as well.
Has anyone read "Psychology Gone Wrong?" I hear it's a great book but a poor translation. An article based on it in Psychology Today basically said a good friend can fill the role of therapy just as well, that it's merely being able to talk through issues with someone empathetic.
I spent my time in the trenches doing therapy, including everything from manualized treatment protocols to "supportive" therapy. I don't think it works much for a lot of reasons, but I love being basically a forensic psychologist only now.
The main benefit I derive from therapy is having someone to talk to. Full stop. Someone who will listen with their undivided attention, and be genuinely interested (or very convincingly feign interest), and understand where I'm coming from, and be sympathetic and non-judgemental, and not at any point expect me to reciprocate by listening to their own brain dumps. Regular people are terrible at the first few things (I don't have a single friend or relative who's consistently capable of even one of them), and it would be unreasonable to ask anyone who isn't trained and getting paid to do that last part. So therapy is my only avenue, and it's a really important one. Someone to talk to. As long as I have that, I'm fine. It gives me strength.
Since this is the part of therapy I find helpful, you can imagine how detrimental it was to my mental health, and my life in general, when I aged out of the therapy programs that will let you see someone once a week indefinitely, and found that the remaining free/low-cost therapy programs only do goal-directed therapy, where you focus on solving a specific problem or learning a specific skill, and generally you're limited to about 10 or so sessions on the presumption that you will have solved the problem or learned the skill by then (and if you haven't then tough luck). I don't get anything out of this kind of therapy. That's not what I need. It's not like I don't know what I should be doing. If I could just up and do stuff just because I know I need to do it, I wouldn't need therapy in the first place. I don't need someone to give me goals or skills. I just need someone to listen, on a regular basis, so that I will have the strength to do those things myself.
I mistakenly read it as "all therapies are bravery debates" and it felt like a profound truth
I think this is on the money. I think it is possible that there are many therapists who justify the existence of their profession by changing dozens of people’s lives for the better. And also that there are the many therapists that cause people to interpret the phrase “go to therapy” as a threat.
I have not met, in person, good therapists, but some of the best advice I have ever received began with the phrase “my therapist said…” so I have to believe they’re out there somewhere.
I agree with everything about this post except for the self-doubt in the end. Hey, maybe I should become a therapist!
I'm sure supportive therapy is useful to more and more people these days. But I have to wonder - if it's basically just talking things through with someone, how sad is it that people aren't already getting that from their lives? Insofar as I have an issue with the rise of "therapy culture", that's why. It seems like a pale, shallow, and *expensive* substitute for something that people should be able to access for free through normal human relationships.
The people in your life might have their own ideas or agendas that you have a good reason to want to get away from.
As opposed to therapists, who would never do things like insert political agendas into their practice.
I don't believe a therapist would go through so much expensive, time-consuming education and make so little money if they had ulterior motives. They don't get self-esteem and a good reputation and referrals from doing their clients wrong.
There are people in every profession who are bad at their jobs or drunk on power--no doubt therapists are the same.
Absolutely. Not everyone is good at their profession. When we hire people, we need to choose well. Same as talking to friends, not everyone is a good friend.
Agreed.
Not "ulterior motives" per se. There's a genuine desire to do good. But toxic enough misunderstandings can cause harm regardless. And the education you're alluding to is specifically inculcating some of those misunderstandings. See the last part of this article especially:
https://bariweiss.substack.com/p/what-happens-when-doctors-cant-speak?s=r
This is a large reason why I have not yet tried therapy. I feel like a crazy person for thinking it, but knowing what I do about the politics of the profession, and the way people with relatively ordinary libertarian political beliefs tend to be treated in academia, I have a hard time trusting a therapist not to treat my closely held moral beliefs like some sort of pathology. I know that concern is probably unreasonable, and that I have plenty of actual pathologies I'm sure they would be plenty busy with without judging my politics, but I've just been unjustly called a racist and a nazi too many times to trust someone who is statistically speaking almost certainly strongly affiliated with the Blue Tribe to poke around inside my head.
If you think it could benefit you, and you have the means, do it. You can always stop if you notice wokeness creeping in in a damaging way. I wouldn’t let this stop me, it’s just the symmetrical counterpoint to “friends/family can have toxic beliefs”.
Counterpoint: therapists (as a profession) *should* be ready to handle you wherever you are to get what you want out of therapy. If you are worried about it, tell a prospective therapist at an intake session. If they freak out, you know you need to look elsewhere.
As far as I've understood and experienced, therapists are not there to engage with the object level of your beliefs, unless 1) you bring that up yourself, and/or 2) those beliefs are disconnected from everyday reality enough to prevent you from functioning in the world.
Therapists are trained to help you "integrate" yourself, ie. diminish the amount of internally generated suffering and wasted energy from different unconnected patterns within your (mostly unconscious) mind fighting amongst themselves. That includes patterns left over from past trauma, but not only that.
The sign that therapy could be of help to you is that, when you look at yourself a bit soberly, you notice that your mind (or body) is often *compulsively* drawn to things you wouldn't want it to be doing, which do not feel helpful to your own goals and life.
That's a skilled job btw, not just something that a supportive friend can necessarily do. OTOH, some people are natural born therapists, and statistically, some professional therapists will be bad at their jobs.
Make so little money? The cheapest therapist in my area charges $125/hour and has no employees to pay. The average therapist in my area charges twice that. Unlike doctors most of them don't have to deal with insurance companies or managing any employees, and don't need to spend as long in school. Being a therapist seems like an attractive proposition if they like talking to people about their problems.
How so, I would think "long education, hard work and little material profit" is far more compatible with a desire of pushing an ideological agenda than anything else.
Mind you, if you are true believer®, the desire to push ideological agenda rarely feels like pushing it, it feels like helping people to see the light and live good life. Ask any religious missionary.
I speak from having been a mental health counselor. I went to college and my best grades and most interesting subjects were Psychology. I got out and looked for a job in marketing but with a bad economy, I could only get a counseling job. Then I didn't want to move up to be a supervisor because I wouldn't enjoy it. My parents paid for college, so I didn't have to think only about pay. And, being a woman, I thought if I had kids, my husband might make more money than me, so I continued. So, we may not get into counseling for a political agenda. Though, high morals vs helping a client hopefully would be covered in the studies because this would be a tough one without help. So blame the education if anyone.
People with political agendas often believe they're doing the right thing
Perhaps, but its easy to leave a therapist if they aren't doing what they are supposed to do. Friendships are more complicated and fulfill more roles.
Right. People may feel constrained in what, how, when, where they say things to friends. They want to keep their friends. We may need more of a friend's time than they have available for us. They may also be friends with a person we need to talk about.
Even if they don't, you may not want to burden them with the details of your problem. I tell people that therapy is the one place you can have a completely selfish conversation. After reading this I suppose your internal monologue is a second place, however it's easy to believe that one's internal monologue may not be as good at it as a therapist.
I'm not sure I have anyone beyond my wife who I would feel comfortable with/able to discuss my deepest issues with for 45 minutes a week. And people who are mentally unhealthy probably disproportionately have friends who are also mentally unhealthy and might not be able to give consistent calm good advice.
It’s also not fair to burden your friends with that kind of time and emotional commitment.
If I'm thinking about what *makes* someone my friend, it's that I'd be willing to take on that burden for them, and I'd expect them to be willing to do the same for me. If I didn't have anyone to turn to in a difficult time, I don't think I'd have friends, just acquaintances.
I agree, but do note that when a friend is distressed and need to work through their issues, being 100% honest with them *without emotional filter appropriate to their mental state* is often destructive. That is, emotional support can often be work. Often very hard work that leaves you exhausted. In the past I encouraged a friend to go to therapy because I found myself too stressed out to give them the support and calm advice they needed. That also something friends do, and I'm happy that I live in a society when we have professional help as a legitimate option. Even if it's partly a symptom of people having less close friends, I think it's also a consequence of people understanding it's ok to ask for help, even if their friends can't provide all of it.
Hmm, I think there's *something* to be thought about with the phrase "in a difficult time".
I've never been or felt the need to go to therapy but it seems like there's a difference between what somewhat would go to therapy for and what someone would call having a difficult time.
I think of therapy as being more for ... chronic (?) ... problems and going to a friend when you're having a difficult time as more of an acute/recent/singular issue.
Many Americans have no friends, only acquaintances.
I tried to be that person for my first two in-person friends after my first run at college. I ended up with severe depression and anxiety for a decade, subclinical depression and anxiety for the following decade, and an aversion to offering help to people. The second decade of aftermath was less severe than the first because of a talk-based recovery group I started attending.
Of course, one of them had undiagnosed, untreated bipolar, the other had undiagnosed, untreated Borderline Personality Disorder, and I have autism. My experience may be skewed.
I would guess so. I've been in a similar situation but was already depressed when I became my friend's "therapist". Honestly, knowing I was helping someone probably helped me stay alive. Although they also ended up seeing a proper therapist for a while.
I think if we're debating "can friends be support therapists?"/"are therapists hired friends" then we should really limit ourselves the normal range most people fall into.
Indeed, if a friend came to me and straight up said they wanted to die and were aleady planning it, or thought their dead father was sending the CIA after them (a delusion I have actually experienced haha), that would set off my outside-normal-range alarm and I would tell them to go to get help.
Your friends can't know everything that you might need help with.
If it is a burden to them, they aren't friends in my book. The kind of people you are talking about are acquaintances to me. Friends are something you usually don't have that many.
Friends are those people you can call at 3am to help you and they will. You are lucky, if there is one such person in your life, let alone multiple such people. There are probably not that many people you'd do the same for. But those are friends.
The fact that they would do it - even happily - does not mean it is not a burden for them.
Then the fact that it's a burden for them does not mean you shouldn't do it.
It's a factor for deciding whether you should or shouldn't.
A "burden" isn't an objective fact, but a subjective description of something. I stand by what I said: if it is a burden to them/or to me, we aren't friends.
If that's your definition of "friends", then I can't say I disagree. But if that's going to be our definition of "friends", then an awful lot of people don't *have* friends and there's basically no place in our society where you can go and say "I don't have a real friend; can I maybe rent one?" or even "I don't know how to make real friends; can somebody give me lessons?"
Except, to some extent, therapists. And a few other niche cases, but you can't count on those being available in any particular instance whereas therapists are omnipresent.
Pretty sure this has been a non-trivial source of business for prostitutes over time....
Loose women yes. Hoes no.
I had a friend who had been a high class outcall escort. She used to say that her job was 35 minutes of psychotherapy and ten minutes of sex.
I'd agree, many people don't have friends. Some, because they themselves are too shallow or too selfish. Others, because they simply didn't find a match.
I have two friends in my life. And surprisingly they aren't the two I had imagined would be my friends when I was a kid. Some lessons really hurt to learn.
True friendship only reveals itself when tested. That doesn't imply that one should force this test. Someone who could have been a friend would probably consider this abuse.
That might be exactly the problem people are describing. It seems increasingly that people can't/won't/don't form friendships, either from lack of ability or lack of place to meet and bond with them, etc. There is likely always going to be a certain percentage for whom therapists are necessary, either because they have persistent problems, or need close friends they can't get (or maybe they need help because their only friend was just caught in bed with their spouse). It is also possible that we are seeing increased therapy demand as people who need a friend go to therapy because they don't have a friend available. My guess is that the increase in demand for therapy is just that substitution effect away from friend to therapist, not driven by an increase in people for whom a close friend or confidant would not be sufficient.
Then again, I would be sympathetic to arguments that something we are doing is screwing people up more, such that they both are less likely to have close friends and more likely to need therapy, friends or not.
There is an enormous difference between happily helping your otherwise competent friend at 3 am when he is in trouble once a year, and helping someone who does that twice every freaking week.
I have helped a lot of people when they were in trouble and I would gladly do it again.
But there are people out there who are truly broken: if you start supporting them, soon you will notice that you lose 10+ hours per week just treating their emotional baggage, grinding down your own mental state and - worst of all - seeing no permanent improvement on their side.
There is time when you have to stop playing Prince Myshkin and eject.
It really depends. If any of my best friends called me at 3:00 a.m. really desperately needing to talk, of course I would do it. If they called me even twice or three times in a row at 3:00 a.m., it would start to be a problem. If they called me every single day at 3:00 a.m., it would jeopardize our friendship. At some point I would lay down a boundary that I need my sleep and I would stop answering the phone at night.
If someone has a very chronic issue, then talking about it constantly, especially if they aren't making any progress, is burdensome on their friends. Also, if one person has a chronic depressive issue, that usually means that their friends will try to avoid placing extra burden on them, which means the relationship is no longer reciprocal--we're both carrying each other's burdens--because one person is overburdened and trying to unload their burden on everyone else.
It can get selfish pretty fast.
I fully agree with what you wrote about friendship. But I feel as if, what you probably perceive as adding nuance, was actually an attempt to steelman what I wrote.
In my post nothing said 3am each and every night. Balance is the key to real friendship. But this balance doesn't need to be achieved instantaneously. Friendship isn't exactly trading either ...
I think most people think of therapy as treatment for chronic issues, is the thing. The people who need therapists the most are people whose friends can't tolerate their level of emotional neediness.
In addition to what they said, it's "fair" because you will presumably return the favor.
I personally see things the opposite way: we are friend because at one point we asked the other person for time and emotional commitment, and we gave it. This is a restrictive definition of friendship but I'm fine with that, there are lots of people that I'm friendly with but that I wouldn't consider "friends".
I also think it's very important that it goes both ways, find some kind of equilibrium. At some point in my life a friend really needed me, and later I really needed them. That's how life goes. I was here for them, they were here for me. That's what friendship is to me. Sharing the good time, helping each others in the bad times, trying to not depend too much on them but also be ready to depend on them a bit if you really need it.
People are saying that we should be willing to help our friends, and I agree—but I also recognize that I rarely befriend highly dysfunctional people, the ones who need the most support, in the first place. And I suspect I'm not alone in that.
Right. There are people who are very difficult to tolerate, very difficult to like. Those people probably disproportionately go to therapists/medical doctors/the nice lady st the library, because they need social support and can’t get it otherwise.
Or even people with great friends might prefer a therapist. I went to therapy to talk about my issues with someone who *was not a friend*. My friends knew my issues, but there was a conflict between how much time I needed to spend working things out verbally and how much of my precious social time time I wanted to spend talking about my mother. I needed that time and those friends free for fun!
My friends also are humans with their own baggage. I couldn’t necessarily talk to the friend with a terrible record for relationships about my boyfriend, or the fatter friend about body image. The friend with a totally deranged mother was wonderfully supportive, but I always felt guilty complaining to her about my only-mildly-crazy mother.
By contrast, I really felt like I could say anything to the therapist. Besides, I was paying him to listen to me! That was incentive for me to be thoughtful and honest, and the whole thing was actually helpful even if it wasn’t life-changing.
Strong disagree. If it is one sided yes, but if there is reciprocity and two-way interest in the emotional well being of a friend that that justifies - demands even - burdening each other with potentially heavy emotional baggage, and this is one of the things that differentiates friends from "friends" (whatever exists between acquaintance and true friend)
It seems to me if you aren't at least occasionally burdening someone you might never reach that sort of true vulnerability and rapport-building that forges dramatically valuable relationships
"occasionally burdening" is one thing. Dealing with a chronically depressed person is "consistently burdening," however. And incredibly frustrating because there is usually little or nothing you can do to help. It's a sad fact, but depressed people who needs friends the most are often nearly intolerable to be around.
I think that's missing, inadvertently, one of the most important parts of most therapy - the therapist generally isn't in the business of giving advice. Calm, good or otherwise. They are paid to listen! Actively, empathically and where possible, encouragingly.
Most people are unable to do this - they can't help giving bloody advice, which is the reason for the splashing out on therapy.
If people don't have friends that can give them a damn good listening to, a therapist may be the only option.
Therapists shouldn’t give “advice” in the sense of “yeah I think you should take that job” or “leave that relationship” but they SHOULD bring expertise and perspective to their clients that couldn’t be found in the average person. They should be obviously well versed in different theories and the science behind what drives human behaviors. Their job, in my view, is to help you understand your thinking (and subsequent emotions and behaviors) and the reasons behind it more clearly, so that you can decide which actions to take for change. Their job is not to tell you what to do or solve all your problems for you.
therapists should more objective and less biased than friends are. Your therapist shouldn’t have any preconceived notions about what kind of person you are or what your family is like a friend would.
Different therapists will have different approaches to how to handle this, and some may even give explicit suggestions when solicited, but I think that in a lot of cases if a client asks a therapist "should I take this job?" or "should I leave this relationship?" the therapist will not only have their own opinion, but try to guide the client around to it. This may or may not be a good thing depending on the therapist's judgment, but a good therapist will have experiences with a large client base to draw on in terms of how various life decisions have worked out in different situations, so giving effective advice to a wide range of people could end up being something they have domain expertise in.
IDK. I would think a good therapist would help the patient to work through the question of "should I take this job?" The therapist shouldn't care about the particular answer. They should care that you are able to make considered decisions for yourself.
I think different therapists will have different views on what a good therapist should do in a given situation. I think that therapists who most people consider to be good will do their best to guide patients to make decisions that the patients will feel better for having made, rather than prioritizing the therapist's own preferences. But if a therapist thinks for instance, that taking a particular job will probably make you much happier in the long run, but that you consistently struggle with impostor syndrome which makes you feel unqualified for anything you do until you've been doing it for about a year, so you're probably going to be strongly biased in favor of not taking it, then I think a lot of therapists are going to see "guide my patient towards taking the job" as the desired outcome, so if they lead you to carefully consider the matter according to your own judgment, and you decide not to take it, they'll feel they've done a suboptimal job.
If a therapist thinks that some decision is most likely best for your happiness, but you're biased against it due to known habitual flaws in your reasoning, then for them, "guide my patient to what I see as the most favorable outcome" and "guide my patient through their habits of reasoning to uncover if they have biases hampering their judgment and holding them back from what makes them happy" will likely be equivalent.
Some therapists clearly inject their own biases and priorities into their guidance quite a lot. For example, I've heard a lot of people recount stories of devoutly religious therapists pushing their patients to conform to their religious views. Presumably, some therapists are going to be more or less committed to pushing their own viewpoints on their patients. But for some patients, the ideal therapist might not be one who doesn't push their own viewpoints at all, but one who exerts a comfortable amount of pressure pushing them towards decisions that actually make them happy.
Agreed and understood. But a corollary - when demand for therapy goes up, it likely indicates and is responding to a decrease in close social connections, a decline in healthy marriages, alienation from family... I'm not criticizing people for seeking a substitute. But I wish the *real thing* weren't in short supply, which is what I see as provoking that response. (cf. Bowling Alone.)
Or potentially a decline of belief in God and absolute moral authority (ETA: priests religion etc)
Priests also used to provide therapy sessions, with free guaranteed absolute divine forgiveness included!
I'd argue that if we look at modern specialized professions, then the traditional small parish priest was effectively doing many of these jobs he was effectively the psychotherapist and marriage counsellor, and the traditional rituals of catholic confession IMHO effectively are structured therapy frameworks.
Seconding this! I think in particular men have trouble forming close friendships, and end up leaning far too heavily on their romantic partners, which makes men who are single (as especially the ones who have just ended a relationship) especially isolated.
Oh I don't know. I think there were many dysfunctional relationships in the past, people just didn't acknowledge them because it made them uncomfortable or bad relationships were gauche.
I absolutely do not think marriages were healthier in the past, there were just more cultural norms to stay in them no matter what. Etc.
Good therapy is not about advice though. In fact, if a therapist is giving lots of advice, it’d be fair to say they’re probably not a good therapist.
Also, there are probably things that you (or anyone) wouldn’t feel comfortable telling your wife- and maybe, or especially yourself, that may actually be at the root of your problems. I think people often think of therapy as a means of getting answers or advice, but often it’s the exploratory process of actually figuring out what the issue is that is most illuminating/helpful in therapy.
If you can't tell yourself how can you tell your therapist? Or are they supposed to be so penetratingly good at their job that they divine these things themselves? That seems like the sort belief that can lead to disillusionment with therapy when you realize that a therapist is just some guy/girl (and not only that but they have 50 other patients and you have spent 1000x more effort modeling yourself than they could possibly ever do)
I've gotten precious little benefit out of a bunch of therapy, but when it was helpful it was never about 'insight' but an external 'professional' agent giving me obvious (but correct) advice which gave it more weight than when I told it to myself. Sort of self-help placebo
I don’t think it’s that they give you the insight, and certainly not that they divine them. They have no special knowledge per se. They are trained to listen and in a method to help guide you to arrive at the insight on your own and together with you. Ideally you’re the one arriving at the insight b/c that’s when it has the potential of leading to lasting psychological change. Giving you the answer won’t effect change in you. It’s a dynamic exploratory process, and (in the more psychodynamic traditions) helps uncover the Unconscious which can be illuminating and helpful at understanding, and at times changing, patterns of thought and behaviors
A good therapist can ask the right questions at the right time because they know how to listen. That’s how it’s possible for you to tell them things you don’t really understand about yourself and why you may be doing things that make you unhappy. Then they can explain to you what they heard, and that can make it easier for you to hear and understand yourself. At least that has been my experience.
That's kind of weird to me, though. The only reason I would go to a therapist would *be* to get advice. I'd see it as like going to the doctor: hey, doc, I have this and that symptom, this pain here and a soreness when I do this -- what does it mean? What should I do about it?
And I'd kind of expect the therapist, like the doc, to say well Carl that seems like a textbook case of Fnord Syndrome, first described by Dr. Whozit in 1899 -- here, let me show you a gruesome plate from my medical textbook -- and I've seen a dozen of these cases in the clinic over the years. Best modern idea is that it's caused by excess hair on your glial cells and the best treatment is gargling twice a day with licorice tea while saying four Hail Marys. Also, stop dating brunettes and give redheads a try.
And I would say thanks! doc and here's $100. I mean, if the guy doesn't know far more than me about how the mind works, and can't give me insight beyond what I can originate myself, then I'm wondering why I'm paying him good money for his education and experience.
I realize this is a caricature, and maybe this is what a good therapist actually does, but by some subtle process of steering me in the right direction in such a clever way that it seems like I stumbled across wisdom on my own, but I would find this tediously circuitous. Why not just shoot straight to the point, tell me what I'm doing wrong and how I could straighten it out? I wouldn't *be* there if I wasn't willing to listen, if I didn't think I'd come to the end of my own abilities to generate insight.
Being willing to hear someone out is very different from being willing to change. Often, the correct path is obvious and everyone gives the same advice, but actually getting someone to break a bad habit is very hard, and is quite dependant on the presentation of the advice.
I guess. I've seen others react that way. I mean, I suppose I'm just saying I'm not a good candidate for therapy, but I'm doubtful that would work well with me. I already usually rephrase internally whatever anyone else says to me into my own language -- like a mathematician always rewriting polynomials into standard form. So it would not matter how the advice was presented, since I would always internally reduce it to the same canonical form anyway. And it would annoy me if someone was clearly trying to be elliptical and diplomatic. I far prefer plain speech -- if it's unwelcome news, I prefer to hear that bluntly rather than delicately. But other people aren't like that, I know, so I get the need.
The problem here is that what you should do (and the reasons you’re not already doing it) in any given situation is contingent on too many particulars of your interior experience for another person to simply diagnose.
A woman I’m seeing has a fraught relationship with her father. He invited her to go on a trip to Nashville and putz around for a few days. She’s torn about it. Should she go? How many questions need answering here? Why is the relationship fraught? Is it rectifiable? How much does she intrinsically value familial bonds? What is the risk that the trip will be good/unpleasant/emotionally destabilizing for weeks? Who can answer these questions except her?
The utility on offer is having another person help you discover these questions and your own answers to them.
People in technical disciplines do this kind of thing _all the time_ - you get together with Frank and discuss how to design Foo to meet all of the constraints, because having another brain modeling the problem speeds things up substantially.
Unlike in technical disciplines, though, we’ve got a bunch of gremlins in our brain that often want to actively deceive us about what’s happening in our lives (and how we’re playing a causal role). Often our values are misaligned with our behaviors, or we’re acting out some patterns of behavior that are difficult to notice from inside of them, and we’ll react negatively to anyone directly pointing it out. So therapists sidestep those defenses with empathy and questions
Sure, I understand nobody has the particular to help with some detailed decision or other, but what I would want (if I asked a therapist for help) would be help with *how* to make the decision, and that *should* -- if psychology has any meaning at all -- be something fairly universal, tied to the nature of the human mind.
So in your illustration, presumably the therapist could listen to *how* your inamorata was planning on making that decision, and advise her where her decision procedure was good or bad.
I understand all your last paragraph except the idea that someone could (1) be motivated enough to deal with the gremlins that he decides to go tell a stranger intimate details *and* fork over good amounts of time and money, and yet (2) would "react negatively to anyone directly pointing it out" as you say.
By me that is almost literally insane, violently self-contradictory. You want to get better or not? If you do, and you can't do it alone, then pretty much by definition you're going to have to hear and accept things that are unpleasant and which don't immediately strike *you* as plausible (because if it were either pleasant or plausible to your own ear, you would have already said and accepted it on your own).
That is, the only reason I would go to a therapist is because I thought I needed to hear something unpleasant and strange to my ear, some kind of kick in the ass that would get me out of the rut of my own thinking. So I wouldn't *do* it unless I was fully prepared for that. I mean, if I go to the doc for a funny wart, unless it's meaningless I expect he'll say "dear me, this is going to hurt as we cut it out, but you'll be better afterwards." Why would I expect the head doctor to be any different?
I mean, it’s not entirely sane, but see e.g. drug addicts who swear they want to get clean and then go do their drug of choice. They’re not a special category, the level of dysfunction is only really special by degree. The reality of the human condition is that we’re not coherent, rational actors. This is what Scott was writing about when he did that exchange with (maybe Caplan?) about mental illness as a revealed preference or whatever.
If you can’t identify places in your own life where you want two things that are mutually in conflict and this has lead you to act out incoherent strategies, odds are you aren’t looking hard enough.
Also, surrendering your judgement to others isn’t a viable or safe path out of dysfunction: this is how people end up joining cults. If your worldview is badly distorted and you can identify that fact, it doesn’t necessarily mean you can just stop it.
You might be interested in “motivational interviewing”, which is a therapy technique for influencing people in the direction you think they should go while still leaving them with autonomy to make their own choices
I work with a lot of men and many of them do better meeting once a month or on an as-needed basis because they don't have the same volume of material (some do) or the same needs to sort things through relationally. Often men only come to see me because they have run out of other options (mom, wife, girlfriend aren't available or helpful) or because one of those women have asked them to talk to someone because they are worn out from carrying the emotional load of the man in their life not having a wider array of emotional supports. This isn't to say anything about you obviously, just something I notice about the difference between many of my men clients and many of my women clients.
FWIW the Venn diagram of people I used to frequently drop acid with, and people I'd feel comfortable discussing deep issues with, is a circle.
Discussing them with your romantic partner is perhaps not a great idea, given that a lot of these issues are either relevant to your relationship (so even talking about them changes the situation, in ways hard to predict) or just scary and unwise to inflict on someone who cares about you the way a spouse/long term partner should.
Personally when I tried therapy, I didn't feel comfortable talking to a stranger about these things and spent the whole time lying / managing the therapists perception of me. Predictably I didn't find therapy helpful
In the end, depending on the problem, I feel more comfortable talking to my family, my spouse, strangers on the internet with similar problems, and close friends. There are occasionally things that are too private even for that, and they go in a private journal instead.
What about group counseling and "support groups"? It seems like an awful lot of people just need some social contact and a sense that they aren't irredeemably defective. Nothing too fancy or expensive.
I use therapy like how I hear some sex-work patrons use sex-work services. There was an initial hurdle to overcome, but once I was past that it was kind of nice being able to discuss those deepest issues with someone who didn't have the perfectly normal, healthy desire to have a symetrical relationship with me that a romantic partner or friend would like to have.
Historically, this role has been filled by religious leaders and phylosophy tutors, and by no coincidence I've availed myself of their services in the past for similar interactions.
I've got a deep pool of healthy friends and and a great relationship with my romantic partner, but having a transaction interaction isn't possible with them and sometimes its just the thing I need.
Also: some of us have mental health issues that make it difficult for us to make and maintain friendships, and give us problems that are hard to talk about to people who don't have experience working with neurodivergent types.
Same here - guess is even more like 45-90 minutes each day with the wife...
That lets me start thinking about some men's claim, that marriage would be to expensive for the personal gain they get from having a wife instead of just a girlfriend or friend with benefits or similar constellations. These men could account the 'cost of having a wife' with the saved cost for a paid therapist (300 per week, 1400 per month, 15000 per year, 0.75 Million per life)
"Should be able to" is doing a lot of work here.
I think you could be reading too far into those words. I didn't mean to imply a moral duty, or assign blame. I'm just saying, it is good for people in so many ways if they have human relationships; it's lamentable that such relationships seem to be in decline; and I don't think therapy can fully make up the difference.
100% agree with you there that therapy cannot fully make up the difference. Also that it's not designed to, and so all the more important that it not be seen as trying to.
It’s not supposed to. That’s not what therapy is. It’s not a substitute for something else, it’s talking to a qualified professional who may be able to help you figure out why you feel certain ways. I talked to my friends about my problems for years, and I still do, but my friends weren’t qualified to refer me to getting diagnosed with Bipolar II and ADHD, something that happened way too late in life for me but might have happened sooner had I gone to therapy. My friends also aren’t qualified to help me recognise and deal with automatic negative thoughts, or to provide me with coping mechanisms when I get too low to do much of anything. I still talk to them and they still listen, and they talk to me, and we all support each other. But sometimes you don’t need a friend. Sometimes you need therapy.
I wonder if "cultivating a network of friends with whom you can exchange informal but high-quality services, such as tech support or therapy" could be one of those useful milestones/life skills that makes therapy more useful for some people than others.
Fuck, absolutely.
I think it's a lot worse with women for a bunch of social reasons - every woman I seriously dated had basically no close friends (to be fair introverts are my type, but come on). This would explain a LOT about the "men would rather..." meme, we just go out for a beer then inexplicably end up spilling our soul to a friend in the morning.
That is almost the opposite of my anecdotal experience, that women discuss emotional issues and mental health with friends all the time, whereas it's very rare for me to do so with my male friends - I can in a crisis, but it feels very vulnerable in a way that talking about that stuff with female friends does not.
I sometimes think that therapy replaces parts of a traditional community e. g. elders / aunts / priests etc.
Arguably a trained expert will be better than "local old person" though.
If we could get a person who had formal training based on science, a mentored internship, and a decade of practice, then a friend's aunt would probably not be the best choice. But give me a mature elder who sees working with troubled people as part of their life work and who approaches the relationship with humility and affection over a first year college grad any day.
Thomas Szasz explicitly compared psychotherapists to priests or "soul doctors".
Local person seems to have a serious advantage in being embedded in your community. They might have more skin in the game because of this, and they have the advantage of actually experiencing many of the same situations you do (though through possibly very different eyes). Therapy feels designed to be *not* very overlapping with your day-to-day life (maybe this is somewhat of an illusion??), which could have it's own advantages (e.g. if your day-to-day life seems fucked up, with no one to turn to).
This is my first comment on SSC. I have enjoyed reading Scott for years but prefer to lurk.
But coming across this post right now makes me feelmlike I ought to have the courage of my convictions.
I've spent a few thousand hours visiting the elderly, lonely, ill, crazy.
And at times I arranged to help others to do the same.
As you can tell by the handle I'm using I'm ambivalent on whether I'm actually interested in being taken seriously in the public sphere these days or not.
But I posted the following tweet today with serious intent. I've matched up the helpful with the needy before and I would guess need is no less now than before.
So even though I preferred my first post before Great Scott to be more polished under a more inspiring nom, if I don't post this now I will definitely rationalize not doing so.
If this speaks to you please DM on twitter.
https://twitter.com/running4fuhrer/status/1506677502059679752?t=zHEMJiP3d28f-p5g_HFr8g&s=19
You know the old joke about how clients don’t pay prostitutes for the sex, they pay them to go away afterwards? Well, therapists can be a bit like that. Sure, my friends will listen to my troubles but then I have friends that heard my troubles! Paying someone who I don’t otherwise have any contact with can be useful.
There's a level of friendship at which it won't bother you at all that they've heard your troubles. It's rare- I only have 2 friends that I'd tell *everything* to.
It's often the case that I need to dump a lot of HARSH shit on someone whose job it is to hear that sort of thing, and who has the training and experience not to take it personally. That's not necessarily the easiest thing for a friend or loved one to hear.
I generally agree with your idea that the loss of social bonds is a bad problem, though.
Another angle to remember is that a lot of people *do* have a supportive community they can talk to every day and get support and advice from, and that community is qAnon.
(Or whichever other extremist/stupid/dangerous community is your personal outgroup boogeyman.)
Therapists aren't *just* someone you can talk to, they're someone with certifications and training and education. If you're surrounded by smart and empathetic people with lots of time and compassion to talk things out with you, they may be better than the average therapist; but the average therapist is probably better than the average friend that the average person could talk to.
As with another profession, I suspect the payment is to make sure they go away after.
The people in your life are not trained specialists who know how to help you process trauma, schemas, cognitive patterns, etc.
To quote the article, we're talking about "supportive therapy", which is "unstructured talking about your feelings and what's going on in your life". I honestly don't think you need any kind of occupational training to provide value by doing that. And what's more, I think the best, most helpful version of it will happen with people who actually know you, not with people you've paid, regardless of how good their training is.
That depends on whether you have a mental illness or not, or trauma to process. I don't think your friend is necessarily going to be able to help you process trauma as effectively as a therapist, no matter how willing they are to be there for you and listen and take you seriously. "Supportive therapy" has structure and theory and modes of practice that a good therapist will adjust based on your needs, not just free form talking without any underlying method.
This presupposes that these trained specialists are actually helpful. Increasing numbers of therapists and school counselors does not seem to have corresponded to an increasing level of mental health in the US.
Only a few therapies are scientifically validated, and only for certain things.
There's no real evidence that any treatment for, say, gender dysphoria is at all helpful.
Conversely, we do have evidence that combination CBT and drug therapy can be effective as an intervention against depression.
I think part of the problem is overdiagnosis as well as the fact that psychology is really more of a proto-science.
Yes it's very sad that most people don't have deep emotional connections they can talk about anything with but it doesn't make it any better to say that. This is kind of like saying everyone 'should' have loving homecooked meals whenever they want them, instead of having to go to restaurants to have a stranger cook for them.
I think identifying the problem is an important part of finding a solution. I think most people in this thread chiming in about their personal experiences with therapy have said they've gotten something from it - great! But for the others who haven't, for any of the various reasons I've seen, we should try to understand how else we might be able to help them.
Also, if the increase in demand/provision of therapy is caused by a lack of emotional connection, that seems... significant? Worth remarking on? It's the kind of thing I come to this blog for, trying to get a little bit better of a lens into how the world works, even when it's not all that actionable.
Therapy is much more than that. Some people can benefit from professional help from psychologists who have deeper knowledge of the issues they are going through. Talking to friends and family is not going to cut-it, instead, it needs to be a professional with deep psychological knowledge.
For example, I had a lot of insomnia caused by anxiety related to my life's issues, which include the fact I am asexual and I work in an extremely competitive field. Talking to family and friends for years only made it worse, then I talked to a PhD in psychology and combined with SSRIs, made an enormous difference.
Don't know about others, but there's at least a few things I get out of therapy that I can't get out of normal human relationships. The obvious one is relationship issues themselves; complaining within a shared social circle is likely to have unwanted side effects, and as a relationship's duration lengthens, fewer and fewer acquaintances are not shared.
(in recent years, meta-politics has become a recurring theme too, because of universal politicization coupled with almost everyone I love going politically insane)
More generally, therapy provides a context in which I can speak without having to vet my words for impact first. I can make statements that are denotative without being enactive. It is slightly more possible to Just Say What I Mean[^1].
[^1]: https://thezvi.wordpress.com/2017/06/28/just-saying-what-you-mean-is-impossible/
The part of this I find disquieting is that if you talk to your friends, they have an option to walk away or not put up with your bullshit if you are too self-centered, or just seem interested in validation and not *really* solving anything. That kind of cold water in the face can be useful, assuming you aren't too narcissistic to interpret it correctly.
But you can fire the therapist, and the therapist is motivated -- at some level, depending on their inherent ethics and level of financial need -- to avoid pissing you off enough that this happens. So it's possible for people to simply hire therapists[1] as courtiers, who will for $100/hour tell you that you're pretty much OK and you don't, in fact, need a kick in the ass to stop being such a jerk.
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[1] Admittedly we would not call these very good therapists, but I'm confident they exist, because I've known people who shop for them, and they do find them.
Oh, they definitely exist, and it's all too easy to end up with that kind of therapist even if you actively don't want to.
I've been to therapists a few times, usually prompted by "I can't stop doing X and it's destructive, please give me advice to help me stop" and they always just metaphorically pat me on the head and tell me I'm doing fine and I should stop beating myself up about it.
I knew someone very well who was in that boat. She went to new therapists hoping for the best. "I already *know* I shouldn't do this, and at some level I want to stop, I just need some practical advice on how to do that." Like she wanted tips 'n' tricks, ideas for mind games she could play on herself that stood a better chance of working than those she could think up on her own[1]. She didn't think much of root causes analyses, because she'd say that's all very interesting academically, but I have a practical problem here, and knowing it got started with this or that experience when I was 11 doesn't do me a damn bit of good solving it.
Unfortunately she never really did find anyone that she thought had anything useful to say, and by and by she stopped trying. She got a grip on her problem on her own, more or less just through enormous strength of will and patience. She ended up being pretty disapointed in therapy per se, though.
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[1] I should say it was her notion, reasonably proved correct by her later experience, that all she needed was to establish a new habit, just *not do it* for a certain length of time, and then the need would dissipate. Sort of like quitting smoking.
I often find myself in this position. I know what can fix my problems and achieve my goals; my issue is typically only ever *doing it*, as a matter of motivation and focus.
That's fascinating. But unfamiliar to me. I don't really have a problem doing stuff I decide to do, even if it's painful or tedious. I'm quite capable of driving myself until physical collapse[1]. The problem for me in not getting stuff done is always not enough time or equivalently too much to do, overcommitment, or an OCD unwillingness to let something go when the return is diminishing to zero.
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[1] Although there's no doubt a healthy slice of pure luck here, because I have never had to recover from a meth or crack habit, for example, which put far greater demands on the will than anything with which I've had to cope. I've never been shot at, either, and had to stand my ground or even advance. So I'm a long way from thinking I'm any better than guys who *have* had that challenge and buckled. I might, too.
Well. I'll tell you why.
We don't have a lot of control over the families we are born into, that's the only family we know, and its hard to see into the intimate mechanics of other families. So, if your family is really messed up, you are probably not receiving important aspects of development, and you don't have the capacity to know what your missing.
I went to therapy because my parents are socially stunted people. I don't mean that in some glib, liberal, snotty way. They both faced social and financial poverty as children, and missed forming important social or emotional skills. I grew up in a house in which I was functioning way above my age since I was very young. Not only did I have to take care of myself, I often had to take care of my parents. Sounds really messed up - but I didn't know that! I was miserable and isolated because I also struggled with social relationships, and I couldn't know why (my parents never talked to me about relationships, just told me that all people were bad and disappointing). I tried to talk to lots of people about my parents, but there are very, very strong (I can not emphasize this enough) cultural norms about ungrateful children, suffering parents and respecting elders, so that many peers and adults will shut down those conversations. Which is to say, I repeated reached out and was denied.
I was lucky in my mid-twenties to go to a therapist. I was able to learn many social skills that I missed as a child. I learned how more typical, if still imperfect, families worked. I unlearned the norm that I had to be close to my parents no matter what, and learned about families that had broken dynamics. I chose a more distant, but more functional relationship with my parents, and I learned how to navigate that, as I didn't have a model of how to do it, and since my parents and society put constant pressure on me to act differently.
Its truly shocking to me, that although I have many Woke and pro-therapy friends that use therapy chatter all the time, that there is still this undercurrent of judgment for not getting along with my parents. Even with good friends, I still have to pull my punches and mostly talk about the sunny side of how our relationship is better. People do not, and willing will not, understand. Most people don't like to know ugly things.
If I had not gone to therapy, I'd be miserable. I wouldn't understand why my work relationships were always so challenging, I'd consistently choose poor dating partners, and I'd have the same relationship with my parents, which made me miserable. I used to have very low self esteem. Everything changed. I'm so glad I went.
Near the end of 8th grade, I wrote a suicide note to a teacher. I had no intention of killing myself, but this brought the full force of the District Psychologist to bear on me. While the school called my mother (a worst-case scenario for me), this man walked around the outside of the schoolyard with me. He told me that we can choose our feelings and responses to things, and can choose to feel better.
I know from having lived in the world for a few decades that this is terrible advice. No depressed person needs to hear this. Universally unhelpful.
That advice CHANGED MY LIFE. I gave it a try...and it totally worked. Between 8th and 9th grade I went from a kid who cried almost every single day to being pretty happy and cheerful. It was a total revolution in my feelings. I mean, what?
All cliched useless advice is great advice to the stupid person (or 8th grader) who has never heard it before. Somewhere in the deep forests is some guy who has heart disease but has never heard he needs to eat right and exercise, And if you told him he would be delighted to learn there was something he could do, and he would never eat fast food again. Everyone else has to hear "eat right and exercise" partly in the hopes of catching that one guy.
Much like the people for whom the 101st “You know, smoking really is bad for you” is what gets them to finally quit.
I have to admit to a lot of respect for that guy in the deep forests who still manages to live off of fast food. Here's to you, Jack-in-the-Cabin Man. (raises travel mug)
That's part of my idea of why therapy works: it provides people with mental models they don't have yet.
Lots of what you write tiptoes around this, btw. The review of the Bicameral Mind most of all, or how you said something about CBT not being the best anymore because it's already in the water supply. Wonder if it's because of your clinical experience.
The obvious alternative to therapy is just culture: you get those mental models through interactions, conversations and, let's be honest, the lion's share would be consuming media. Which means a society's media is a lot more important and useful than it's usually given credit to.
The next obvious step would be designing stuff specifically for teaching concepts, like EY did with HPMOR. I have no idea how widespread doing this deliberately is, as opposed to concepts just randomly ending up included in various works.
I think there are lots of things people have heard before but haven't updated enough on. Rehearsing the obvious could help with that even if everyone had already heard it. Religions are constantly encouraging people to re-read the same text. I don't think this would be a universal feature of religions if it didn't accomplish something. OTOH schools don't encourage students to re-read the same text unless they're studying for an exam.
I imagine an alcoholics anonymous meeting has the effect of constantly rehearsing "alcohol is bad" and "we try not to drink anymore" and "we support each other", with moderate effectiveness. Sometimes people really need to hear things again that they've already heard.
Walking people through things repeatedly step by step can help.
I like the zen book example: You have a broken teacup. You can be happy or sad, your teacup is still broken.
Sometimes a stranger's advice can help. And some people know just the right thing to do or say when they see a problem. That particular person might make a very good therapist. Anyone who is not as lucky as you could pay a therapist in their office. Paying makes you take things seriously. As a mental health counselor, a neighbor called me to say her daughter has tried to commit suicide. What should they do. I said call an ambulance and have her taken to the hospital for an evaluation. That turned things around. The girl had to decide at that point if she was serious about living, serious about being labelled mentally ill. She chose to take control of her life and find something good in it. And not make her parents pay for another ambulance ride.
Is it possible that the difference between the 8th grade you, and most depressed adults, is explicable in terms of something like an accumulation of evidence _against_ the proposition "i can choose my feelings and responses to things?"
I use a 'higher resolution' of this belief, but it's much more like "over long periods of time, i can choose how i feel, which i do by changing the outermost narrative frame i use about my current state, and then after some period of time, my emotional state follows."
The more often i repeat that practice, the shorter the time period it takes for me to adjust my emotional state. So now i'm at a place where hearing 'you can control your feelings' really DOES work. But i think what a lot of people hear is, "you can control how you feel in each moment with 100% accuracy," instead of something like "your emotoinal state is ike the momentum of a large object; you can exert some force on it on that object, and, over time alter its trajectory."
Yeah, this totally makes sense. Also, I didn't turn out to be a depressed adult. Did I get just the right advice at the right time? Or am I just not prone to depression and was just momentarily stuck in a cycle of sadness (I mean, middle school, you know) that I was able to snap out of?
I find I often can snap out of feeling bad by a smallish act of will. I'm sure this is like how some people can remain slender by just "not overeating," while others of us are fat, and not for lack of that simple advice.
I prefer the framing of reality tunnels (Wilson/Leary) - you live in a world of your own design that's based on an objective reality somehow but that doesn't really help. Choosing a frame in which you view an event is way more powerful than choosing your response (which is artificial and to be honest, other layers of your mind know you're full of shit).
Some people are also just better at it than others, I think. I suspect that practicing it also makes it easier.
You can quite literally emotionally drop a subject internally if you are practiced enough at it.
Biofeedback is great. If you just make the face that you would make if you felt a certain way, you start to feel that way. I use this often. Plus lots of fresh air, exercise, and a healthy diet. I'm the only one out of six adult descendants of my maternal grandmother who doesn't seem to strongly need antidepressants. But I'm about to start 150mg of bupropion XR anyway, just to see if that makes me even better.
When you say biofeedback, are you talking about a digital fitness watch for example? It takes a lot of time to get fresh air, exercise and healthy diet, so it means you are in control and taking care of yourself. You are not letting your time go to excess work or other demands. You are living within your means with a healthy work/life balance which it not easy to achieve. I applaud you for setting limits. I have taken Bupropion XR and it helped when needed. But I also found that when I was not prescribed it and had a few extra pills, I was able to get the placebo effect by taking only one pill. I reached for something to make me feel better and soon I was better. I did this several times with the same good results. Glad I didn't try dangerously addictive drugs instead !
No, he's talking about "If you just make the face that you would make if you felt a certain way, you start to feel that way."
So I've taken the second dose of 150mg of bupropion XL (the smallest pill they make) and I already noticed a big improvement within an hour after the first dose. I have much more motivation to get things done instead of sitting around playing video games or watching TV. I've organized my closet, organized my social media, signed up for lots of social events, cleaned my apartment, and completed other annoying tasks I'd been putting off for too long. My sleep is still fine and my focus has improved so I guess I'm not manic? Maybe being normal feels sorta manic compared to how I usually am? There are no side effects worth mentioning yet.
All in all I'm really glad I made the decision to try it. Many people may not realize what they're missing, like a fish doesn't notice the water he swims in or have any concept of dry land.
It's possible it's not just the medication that is working. You know what you need to get done and know help has come. You're more motivated to help yourself now that you don't have to do it all alone. Good for you!
Growing up, my mom had a sign in our home that said "most people are about as happy as they make up their minds to be". I've been online enough to know that if I try to tell this to someone on the internet I'm signing up for a mob lambasting.
BUT for me, it's completely true! Pretty much every time I'm acting like a giant curmudgeon, it's because I'm making a prideful choice to be grouchy and could "snap out of it" if I just set aside my expectations of what I deserve and choose to be happy.
So, I agree. What?
So we have some evidence for people who are "high" all the time. Basically some people are just naturally happier. So it might be the case that some people *can* just choose their feelings but many others can't and we all know how trying to treat everyone monolithically ends up.
Self control is the natural state. People with certain mental illnesses are people whose ability to do this is damaged in some way.
The notion that this advice doesn't work is actually one of the Big Lies. It absolutely works.
Normal, mentally healthy people can indeed choose how they feel and how they choose to react to things. In fact, this is even true of most depressed people.
It's the first line of advice for anyone who is having problems because it turns out that you actually can control your own emotions and you can choose how to respond to situations. Understanding that you have agency and control over your own life leads to massively better life outcomes, and people who understand this do better in life than those who don't.
Indeed, a lot of depressed/anxious people are the same way - they can in fact choose how they respond to stuff, they just sometimes forget that that is the case. For some of them, their feelings end up ovewhelming them.
The people I've seen emerge from severe depression, it's basically them slowly teaching themselves not to go down negative mental pathways all the time, training themselves to not always feel bad/default to pessimism, understand that other people aren't out to get them, that everyone isn't about to turn on them because they said "the wrong thing", etc.
That's why the medications help, I think - it helps them not immediately go down the bad mental pathways and gives them space to "reprogram" themselves, so to speak.
People can choose to be happy, sad, or angry. They can choose how they react to these things. That's what makes people *people* instead of animals.
This is why phobias can be overcome as well - they can gradually be desensitized and learn that whatever the phobia is isn't actually harmful and dangerous. But they have to build up an intuitive understanding of it - it's not enough to say "it's silly that I'm mortally afraid of insects", they have to actually get it baked into them on a deeper level.
Honestly, I wonder if some people are simply inherently capable of accessing a "higher level" of self-psychological tinkering, and are simply never diagnosed as being phobic or anxious or whatever because they are simply capable of doing this on their own and overcoming that intuitive response and controlling and reprogramming it, and it is only people who have some sort of issue or deficiency that cannot.
It's worth remembering that many people don't experience PTSD after undergoing trauma; most people are just fine. It's the people who have problems that we remember.
Nice summary!
I’m sure that talking cures can help people. However how much, if any of this, is down to the supposed founder of psychoanalysis Herr Freud? Has he been overthrown.
I occasionally watch Fraiser on syndication and he’s supposedly a Freudian - but when answering people’s calls it’s generic helpful advice, I’ve never seen him suggest that the caller’s problem is his love for his mother, his death wish, or her penis envy.
Is any of this science? Is CBT science. Or is all that is happening is that there’s a helpful person there when you need one. How would be know anyway? It could be all placebo effect, which means it works, because that’s also a change of mind.
Hypothesis: Freudianism works by giving the patient a terrible explanation for their problems, which they strongly reject, forcing them to figure out the actual explanation for their problems.
"I have problems concentrating at work"
"That's probably because you want to have sex with your mother"
"What? Ewwwww, no! It's probably just because I drink half a bottle of raspberry schnapps every morning. Maybe I'll stop doing that."
Ha! Probably.
That’s a view of Freud that’s based on 90 years of stereotyping and simplification. “Freud was a guy who went around saying people want to have sex with their mothers because he hadn’t heard that theories should be based on evidence” should hold as much credence in your mind as “Rationalists are people who think we should all act like Spock all the time because they haven’t heard that emotions are actually important”
If you want to develop an actual hypothesis of ‘freudianism’ you’d have to actually, idk, read a book. But maybe you can’t. Maybe you need the act of understanding to be passed on to the Other so that you’re freed from either the joy or the obligation of knowing what you’re talking about.
I’ll be honest here. That’s not much of a defense of Freud as it is a an hominem attack on Melvin.
Asking someone to read a book isn’t much of an argument anyway - you could make that argument about the Bible, an astrology book, or the books about aliens building the pyramids. Also the assumption that people haven’t read Freud begs the question. I’ve read Freud which is why I’m unmoved by his arguments in general. There’s a few things he got right. Projection for instance.
On that subject, your last confused paragraph was about The Other; apparently anybody who dislikes Freud is a cad who expects somebody else (and not just anybody but the Other) to read the book. This is a charge of bigotry.
But isn’t Melvin and other people people who haven’t, or have read, Freud but don’t like him in fact your “Other”. Haven’t you ledgered them in your head in the bigots column without evidence. Are you not projecting?
Sorry, I should have clarified. I was talking about another Other, not Freud’s Other.
I do sometimes wonder if Frasier gave a lot of people a string negative perception of psychiatry. Certainly seeing it as a kid caused me to take the field less seriously
I thought he gave decent advice for a radio shrink. Not that he needed a degree for that. It’s actually when he went into more Freudian analysis that it sounded phoney.
The whole joke is that Frasier holds himself up as self-important 'learned' doctor while being a dime store sell-out, radio shrink and Niles, who has stood true to his academic roots, holds him in contempt for this
Abt last paragraph, SSC has a post on that, "Scientific Freud".
"I was taught the following foundation myth of my field: in the beginning, psychiatry was a confused amalgam of Freud and Jung and Adler and anyone else who could afford an armchair to speculate in. People would say things like that neurosis was caused by wanting to have sex with your mother, or by secretly wanting a penis, or goodness only knows what else."
"Then someone had the bright idea that beliefs ought to be based on evidence! Study after study proved the psychoanalysts’ bizarre castles were built on air, and the Freudians were banished to the outer darkness. Their niche was filled by newer scientific psychotherapies with a robust evidence base, such as cognitive behavioral therapy and [mumble]. And thus was the empire forged."
"Now normally when I hear something this convenient, I might be tempted to make sure that there were actual studies this was based on. In this case, I dropped the ball."
"(...) largest study ever to compare Freudian and cognitive-behavioral therapies. It examined both psychodynamic therapy (a streamlined, shorter-term version of Freudian psychoanalysis) and cognitive behavioral therapy on 341 depressed patients. It found – using a statistic called noninferiority which I don’t entirely understand – that CBT was no better than psychoanalysis."
But both beat placebo. About that...
"Dodo Bird Verdict (...) psychotherapies work by having a charismatic, caring person listen to your problems and then do ritualistic psychotherapy-sounding things to you, but not by any of the exercises or theories of the specific therapy itself."
"if the Dodo Bird Verdict and the active placebo problem and so on are equally true of all psychotherapies and all psychotherapy studies, how come everyone become convinced that cognitive behavioral therapy passed the evidence test and psychoanalysis failed it?"
"And the answer is the CBT people did studies and the psychoanalysts didn’t."
"That’s it. It may be, it probably is, that any study would have come back positive. But only the cognitive behavioral people bothered to perform any. And by the time the situation was rectified and the psychoanalysts had (positive) studies of their own to hold up, “everyone knew” that CBT was evidence-based and psychoanalysis wasn’t."
I did say that talking cures work, for the reason that many people here agree on, just talking to someone who is intelligent will probably help you. So its possible that CBT and Freudian analysis work because of the talking, rather than than the deeper theory.
The "Dodo Bird Verdict" version I think I remember said there seems to be better and worse individual therapists, but not better and worse kinds of therapy. (Also, you can get a lot of the benefits of therapy by simply keeping a journal without actually paying anyone to listen.)
That's accurate. I work in the therapy biz (on the admin side) and it's well known that some therapists are just terrible, most are mediocre, and there are a few hot shots in any local market that everybody recommends because they get results. Typically these are the people who end up with a 6 month wait list for a new client. You get a lot of people who come in with the same story: "We tried therapy before, but the therapist wasn't good." Some people have enough insight and experience to be able to really cut to the heart of peoples problems and help them improve, regardless of model.
Frasier was more of a Freudian on Cheers. There was an episode where Woody reunites with an ex-girlfriend from his hometown, and the two of them begin to overeat tremendously, the way they did when they were previously dating. Frasier asks Sam what he thinks, and Sam gives what sounds like a reasonable pop-psychology answer - but Frasier says no, they're obviously sublimating their desire to have sex with each other into a desire for food, and tells the two of them to go get laid. (Which, thanks to TV logic, actually does solve their overeating problem!)
> But also: people vary really widely in their ability to do something sort of like hold a conversation with themselves - for example, some people totally lack an inner monologue. Nobody has ever checked if those people benefit from therapy more, and I don’t want to actively predict that they would. But I know that I talk things over with myself a lot. Does this help me stay emotionally stable? Not sure; seems plausible. If I didn’t have an inner monologue, maybe the only way I could get that same effect would be by talking them over with another person.
I would say that I don't have an inner monologue (I also have aphantasia), but am generally able to process my thoughts and stay emotionally healthy. I primarily rely on one-on-one conversations, mostly with my spouse, in order to hash out ideas. I also probably have some genetic predisposition to stay emotionally healthy -- at least that's what others have told me, and that seems like a good thing to believe so that I don't go around telling others, "why don't you just try to be more positive?"
I also have aphantasia and lack an inner monologue. I think the predisposition to stay emotionally healthy is the lack of inner monologue itself. With no rumination it is nearly impossible to be self critical or worried for more than a few minutes. Journaling and writing have been helpful to hash out ideas.
What is the process of writing like for someone who lacks an inner monologue? I'm assuming the words don't just appear on the page and must exist in your mind at least briefly? Is it just that when you're not actively trying to produce language, it doesn't ambiently exist in your mind as a sort of voice describing / directing your actions?
> Is it just that when you're not actively trying to produce language, it doesn't ambiently exist in your mind as a sort of voice describing / directing your actions?
Yes. Instead, I usually think of the specific ideas I want to write about, then translate them into words; usually I can do the latter more or less immediately, but occasionally it takes me a few seconds to think of the right word, or come up with the right phrasing, to represent the idea I want to express.
Here's a long but great piece by Blake Ross, who's aphantasic, on this:
https://m.facebook.com/nt/screen/?params=%7B%22note_id%22%3A2862324277332876%7D&path=%2Fnotes%2Fnote%2F&refsrc=deprecated&_rdr
He wrote the script for Silicon Valley S3E1; ctrl+F "How do you write fiction if you can’t visualize scenes?" for his commentary on that.
> I think the predisposition to stay emotionally healthy is the lack of inner monologue itself. With no rumination it is nearly impossible to be self critical or worried for more than a few minutes.
I think these are two different things. I don't have an internal monologue, but I have had recurring self-critical thoughts of the sort you describe.
I have no idea if I have an internal monologue. When I'm planning on writing something, or if I'm having a debate in my head, I have a clear inner voice. But I can't tell at all if I have an inner monologue at other times. Every time I try to observe my thinking everything goes quiet. This makes sense: it's a bit like trying to see what you look like with your eyes closed by looking in a mirror and closing your eyes. If I'm thinking about observing what I'm thinking all I'll find is observation with no content, because all I'm thinking about is "What am I thinking about?"
It seems like if I'm mulling something over in my head I have a monologue, but it feels a little forced? I have to make a mental effort to get in the headspace of "Lets figure this out." When I'm just going about my life, thinking, I can't tell if the voice is there. Because if I start thinking about whether I have a voice then the voice will be there.
Anyone else in a similar boat?
Therapy is like having a friend that you can tell anything to and they can't get mad, leave you hanging, or tell anybody else. For people without close friends (which is a lot of people) they can work wonders.
I think that's true, but that also more complicated things are going on. I spent most of my life without close friends, but I didn't have (and don't think I would have benefited from) a therapist, because for me talking over my problems with other people doesn't make them better.
(cue gasps of disbelief and me pointing at the post I just wrote)
The only circumstance where sharing a problem with someone makes me feel better is if they turn out to have the same problem. That's a great feeling!
Presumably though, the first rule of therapist club is never to disclose personal details to their patients, so no joy there.
Speaking as someone who used to talk to myself a lot, and now talk with myself more often, I would say that an inner monologue is not nearly as useful as an inner dialogue.
And while I’m at it, watch with all the dumping on Freud?
Ego
Super ego
Id
The subconscious mind
Infantile sexuality, or the sexuality in very young people.
Freud never said that people wanted to have sex with their mother literally, (although clearly some do).
I think it’s much more reasonable to think of the extreme bonding of attachment that takes place as a small child, and the integration of physical sensations as information is obviously much greater in very young children. Those things are the predicate for one’s sexuality. I don’t think that’s very controversial.
I think Fraud was a very smart man and he came up with a lot of very useful concepts.
CBT is repackaged Buddhism. I happen to think they’re both useful.
On a sarcastic note I would say that there’s two classes of people who are completely comfortable with their mental health, people who are truly mentally healthy, and people who have talked themselves into believing that they’re mentally healthy.
For everyone else there is some form of therapy. I don’t think that one should underestimate the local priest historically in these situations.
It isn’t always possible to sort something out by yourself or with people you are invested in. Think of it as playing tennis with a better player. Is that a crazy thing to do if you want to get better at tennis?
I heard that the "wanting to have sex with your mother" thing was kind of an artifact of Victorian child rearing practices; among other things, Freud had a wet nurse, so the conditions for the Westermark Effect might never have occurred.
https://www.damninteresting.com/too-close-for-comfort/
Very interesting.
Damninteresting….
There’s something there.
Perhaps a properly resolved Oedipus complex could be described as a successful transfer of “desire” to an appropriate object
Appropriate in the sense of incest avoidance.
One’s mother showing up late could make her a target.
George C Scott and his wife starred in a film revolving around this conflict back in the 70s I think It has a reputation of being a bit of a stinker and I’ve never seen it but it did tackle this thing head-on.
The most beautiful film on the subject I think is murmurs of the heart by Claude Lelouch
> but I didn't have (and don't think I would have benefited from) a therapist, because for me talking over my problems with other people doesn't make them better.
I thought the same way, but at some point I decided to go to a therapist anyway. One of the main things my therapist tried to teach me is how to receive and request empathy in a way that is comforting to me. I had never learnt this in my family or elsewhere during childhood and at first I felt too vulnerable to really receive any comfort from any form of sharing.
But with some time I became more open and experienced enough to request the kinds of responses that would help me feel better. I think the important point is that "talking about problems" is not about solving the problem, but about feeling seen and heard by someone and receive empathy. I also think that the vulnerability that is being introduced on both sides in such an exchange is the foundation of feeling emotionally connected to other human beings.
Heh, so this is why you wrote it a bit defensively. I was the opposite, always having friends to talk to and who talked to me, and for me the post seems extremely non-controversial.
I have a lot of close friends, and that's been true for years. I feel comfortable talking to them pretty openly about my problems and emotions. They don't get mad at me for anything I say, or leave me hanging, or share my secrets. Regardless, therapy was helpful for me and made me more emotionally stable.
I had weekly time to speak to someone about my emotional reactions and figure out which reactions I wanted to work on (and how I would do that). So e.g., these days, if I get unreasonably panicky about feeling sick, and that panic is causing me a lot of suffering, I have all sorts of coping strategies that make me suffer less, and therapy helped me learn those coping strategies.
My friends helped with this too, but it's easier to debug my brain if I can have many selfishly one-sided conversations. And I'm more likely to attempt to follow mental health advice from a therapist than from an average friend, because I think the mental health advice from a therapist is more likely to actually work. (I hope I'm right about this, but not entirely sure.)
However, I think a good rationalist could've served the role of a therapist for me (without therapy training -- just CFAR training or equivalent). I think that could've been even better than working with a therapist.
Looking for somewhere to insert my two cents, but I've never felt this with a handful of therapists over the years - if anything, I always felt less able to have a conversation with them.
Not that I could have deep conversations with other people about feelings or mind-workings with other people until relatively recently either, but I'm kinda surprised by this characterization because I've never felt it to be true.
When a lot of people talk about therapy, they're talking about a very idealized version of how it should ideally work. Most therapies don't work as they ideally should. Anecdotally, I went through about 8 therapists as a child, and was somewhat surprised when I finally found one as an adult with whom therapy seemed to work.
I went to a counselor once for a problem I was somewhat embarrassed about. I talked to them for a while and they had some suggestions, which I filed away. But the problem never recurred, and I think part of the reason was that I really didn't want to sit in front of this high status person and explain how I'd failed to apply the really basic method they'd taught me.
I wonder how many people get a similar benefit from therapy - better not relapse, lest I have to explain it to this expensive professional?
Yes - part of what I got from paying a therapist was definitely 'accountability' - feeling an obligation to have done my homework / to actually try things out when asked to do so in session rather than just going 'hmm, that seems like an interesting idea' and then not actually implementing it.
Thirding this. Got very basic advice my friends had told me before, but hearing it for an hour every week is a bit different than once every few months, the accountability was much higher
“ some people totally lack an inner monologue”
I was totally shocked when I first learned about that. How can it possibly work? If they are waiting in line at the grocery store what do they think about?
Freud: "sex with their mother!"
Lacan: "status"
Jung: "how much they dislike the cashier for being too mean/nice/weak/aggressive"
I still think about things in line, the thoughts just don’t have words in them.
How can you have thoughts without words? Rather than think, “I need to get gas and stop at CVS.” You see the low gas gauge and the item you need at CVS in your mind?
That's what I would guess. The same way that a lot of speed-readers recommend not thinking/vocalizing the words you read and thinking in the concepts they represent instead.
Do people really vocalize/think the words out loud when they read? I do not do that, and assumed other people didn't either. It just sort of washes over me and I understand it without thinking about it.
Yeah. I do it, both when reading and writing, there's a specific "voice" I hear. I've taken a speedreading class and have tried forcing myself to make the words "wash over me"; I can kind of do it, but it's effortful and feels like I'm missing things.
Lots of people do. I'm a fellow "absorber".
At least for me, if I pay close enough attention to my inner monologue I realize that it's actually following just a bit behind my actual line of thought. I suspect that for everyone thinking actually has nothing to do at all with monologuing, and you hear a little voice for other reasons. What reasons those would be I could only guess, but considering I've often struggled to put an insight into words while being perfectly able to think about it, it must be true.
I sometimes finish a thought before the monologue expresses it, and stop thinking the now-redundant monologue. But then get a sense of incompleteness until I've gone back and thought the end of the monologue as well. (It's a similar incompleteness-sense to that inspired by a Ctrl-C without a Ctrl-V, or an unclosed parenthesis
YES! Every once in a while I feel the urge to try and ditch the extra work of the monologue, and sure enough that sense of incompleteness screws it up every time. I feel like the most likely explanation is that it takes conscious effort to notice the overhang, and that attention interrupts the silent stream of thought as it tries to stop the loud one.
I often have a voice in my head constantly thinking about how to describe what is happening in my journal later. I suspect this is a consequence of journaling.
Concepts activate in a kinda felt-sense fashion, sometimes these compress into a linguistic-like 'sentence' that's rememberable. So I might be thinking about what I need to do (non-linguistic, just a feeling), scanning through some association-triggers - for home? for work? food? (still nonverbal), remember something, and have a verbal restatement of what I remembered which brings it more fully to attention: 'Oh, I need to buy toothpaste', or more likely just 'toothpaste' as a single word
I'm still trying to get over the fact that when someone says "picture an apple" most people just have a picture in their brains of an apple. For me it got translated to "you know what an apple is, so think about that." Would have never occurred to me that thoughts came with pictures.
I can sorta picture things if it’s relevant to a problem. Like trying to do geometry in my head I usually summon a little picture. But if you ask me to think about an apple it’s just a rough assembly of concepts.
I had this sort of thing with depth perception. I could never figure out exactly what people meant when they said "depth perception" since I always judged stuff by a variety of visual clues. And then I got sunglasses that let me see depth, realized I hated it, and got the prescription removed from my sunglasses.
I have an intermittent inner 'monologue' (after considerable meditation, I used to have a much more active one, and it's rarely been a singular voice / train of thought).
What am I thinking about in line at the store when my monologue is quiet? Possibly a detailed impression of a sense impression I'm taking in, possibly I get some internal music playing, possibly a memory of a sense impression (or a mixed / made up scenario or dream), and possibly just literally nothing - I'm not sure if those times I'm really thinking of nothing or just not bothering to form memories, it's somewhat hard to tell!
I was surprised when I learned that for many people, "inner monologue" was not a metaphor for thought, but it meant that people literally have words going through their mind most of the day.
I mean, compared to pure ideas, words seemed so slow, so imprecise, so low-bandwidth. And so distracting--if your head is talking to you, how can you ever focus on anything? I thought it was a miracle such people could get anything done!
You have thoughts too. You just use words to discuss with yourself the merits of a given thought.
For me at least, thought words are significantly faster than spoken words. That doesn't really help with the imprecision and low bandwidth, but those are obstacles you're going to have to overcome when it comes time to communicate your ideas anyway, so I don't consider that much of an issue.
Well how do you translate your thoughts into a form that you can apply external knowledge to?
If I need to apply external knowledge outside my brain, such as in writing or math or some such, I translate them into words or diagrams. If I need to apply it inside my brain, there is no translation needed. They are already in a form that can be altered by learning, even if the learning itself consists of word-transmitted ideas.
Pure ideas are indeed extremely fast but putting things into words has a way of structuring and organizing thoughts that would otherwise be aimless and ephemeral. I am able to think without words if I try really hard, and it lets me think *fast*, but it doesn't let me think *well*.
Around 18, I began to think in words sometimes, and I probably do so now a majority of the time. I miss thinking without them; it felt faster, more pure, and I felt more creative and less constrained by the ideas available to language. However, I am a more precise and consistent thinker now than I was before, which supports the "thinking well" angle. Though this is after aging a decade, getting a physics degree and studying rationality, and I'd guess that some or all of that matters as much as or more than thinking in words.
The one thing I definitely credit to the change is that now I am able to converse much more fluidly, and I never lose words just on the tip of my tongue. Before, I would have to translate my ideas into words just to speak them. That was a fast process, but it was slower than just having it all come out like it does now. I often felt left behind by a conversation that had moved on before I could assemble what I wanted to say about a topic.
As I read your comment I was simultaneously actually saying the words "two, four, six, eight, ten, eleven" in my head as I counted knitting stitches. I do not think I could count absent words. Even trying to glance around the room without thinking "words" - I looked at the lamp, and my brain threw up the word "lamp".
Separate question: do people who are good at chess see a chessboard in their minds? I am terrible at chess, so for me, it might as well be trying to imagine what's going on in the brain of a different species.
I don’t play chess much, but I can visualize a chessboard in my mind. If I try to play a both sides of a mental game of chess, it’s hard to keep the entire board state consistently loaded and evolving according to proper rules (the thing that tends to get me first is accidentally moving bishops not-quite diagonally), but I think with more practice it would be totally possible for me to run a functional “mental chess-engine”.
In fact, given that various chess players have played blind chess successfully, they must be maintaining a mental map of the board.
I see a chessboard in my mind, and I visualize a chessboard in my mind even if I'm also looking at a physical chessboard. Part of that is thinking ahead, but part of that is that when I visualize the board, I visualize the relationship between the pieces.
When a diagonal line of pawns all protect each other, I imagine them being linked together into a chain. A rook can be "holding onto" a piece it's protecting across the board, a king is projecting a forcefield that stops the other kind from getting close... now that I think about it, not all of these have real visualizations attached, but they definitely all have concrete locations on my mental chessboard.
Maybe it's a bit like feeling the location of the pieces and their movement potential the way you feel the positions of your limbs. Wanting my knight to move one square over feels like wanting to touch my elbow with my hand (on the same arm).
That's really interesting, both. I can't do that at all. Everything in my mind's eye is very "impressionistic".
I have nearly always counted in words, and often if I'm thinking about a particular type of thing, like a lamp, the word is part of how I think about it. But though I'd think the word "lamp" when contemplating a lamp, it would never appear in a grammatical way as part of any larger thought, like, "I should turn the lamp on".
One thing I am sure of, pace others in this thread, is that I cannot control my thoughts whether momentarily or from day to day. Or, I believe I can't and maybe there is ultimately some hubris there. Controlling my behavior is the imperfect best I can do.
I often try to control my thoughts, sometimes successfully.
I think in words, but do so at insanely high speeds - faster than I read, and I read north of 500 words per minute.
I also think in concepts, which is similar to reading without an inner monologue.
They're rotating cows in their minds.
these shape rotators smh my head
Yes, I had to look at some other links for that. Someone mentioned a condition called Aphantasia earlier, that's present in 1-3% of the population.
Just as an example, don't know how they could play chess.
I have aphantasia and have given up on chess. I just can’t do it.
I used to play tournament chess, and was rated expert at one point. Long games are all about inner monologue (blitz is more System 1). "Ok, I push to e5, kick his Knight back, then I've got Ng5 and Qh5 setting up an attack, but is that gonna work? He's got Nf8 seems to hold everything" like this for 4 hours.
Youtube has got a bunch of 'banter blitz' videos of elite players doing this - talking to themselves out loud. This one is Magnus Carlsen and the wunderkind Alireza Firouzja: https://www.youtube.com/watch?v=CYVBlclO4kQ&ab_channel=ChessPress
As one of the folks who has this problem: Badly.
Fun fact though! I received an ADHD diagnosis late in life and use chess to train executive function. There are some studies that link attention issues and poor non-verbal working memory (essentially the ability to hold images in your mind). A single, not very good study in children found that a daily chess game improves non-verbal working memory and ADHD symptoms.
That's cool if it's helping. Chess does train focus and pattern recognition skills. Lichess.org has some good tools like puzzle streams, good online club.
I have never been very good at mental picturing. I don't think I have aphantasia; I can summon something that feels like a mental picture, and it takes work and focus. But the pictures are so faint that I'm not certain whether I'm actually "seeing" them, the way people describe, or just sort of feeling the residue of what it would be like to actually see the thing.
I've always been very good at keeping track of where things are in spatial relationships to each other though! Mental rotation is easy, and so is imagining geometry, or objects arranged in some specific configuration. When I imagine a doorway, I kind of intuit the disembodied shape of it, in a way that feels kinda-sorta visual like I can "see" the rectangle with those dimensions, but it doesn't appear in my mind as an image I can actually see at all, much less an image of a particular doorway with details.
I'm not good at chess (maybe 1300), but I "see" these ghostly shapes when I play. Every piece has its position, and there's a sort of line of force emanating from it to every the space it can move to. I actually don't know why anybody would care about being able to see pictures while they play chess, or how it could help at all. Don't you just know where the pieces are, and where they can move (and where they can move from there, etc.), and that's enough? Actually having a picture of a chessboard to go along with it just seems redundant.
Probably having the details of how the knight looks is redundant, but there is definitely an advantage to being able to "picture" where the pieces are after a move. Humans are very limited in how many explicit verbal ideas they can hold in their working memory at once, but much less limited in non-verbal memory. This is why magicians who do memory tricks (like memorizing a whole deck of cards) will talk about a "memory palace." If you try to just keep a running list in your head of each card, most people will max out around 7, though some folks can do more. But if you have strong non-verbal memory, you can create a visually interesting mental space that contains each of the cards, and then just sort of tour it to get the order. That's an extreme use of non-verbal memory, but there's a reason they use that technique.
It seems likely that non-verbal memory takes a lot of different forms. For instance, I am almost entirely aphantasiac visually, but I can easily conjure sounds and smells. So it may not be necessary that you literally be able to form pictures to get the advantage of this expanded holding capacity while playing chess.
But it is absolutely true that if you have bad non-verbal memory (as I do), trying to imagine the board state after 2-3 promising moves 2-3 moves deep quickly becomes like trying to hold 20-30 bowling balls. You have to not only know where the piece you're moving will end up, but also what new files or diagonals are opening, etc.
Some preliminary studies suggest that regular chess practice may improve non-verbal working memory, though often promising work in improving that particular skill turns out to be bunk.
Aphantasic, I only play chess in correspondence mode where I can move things around :P
I had to teach myself how to make mental images to try and learn how to draw and do art.
I didn't have any real problem playing chess, because I didn't think of the chess board as an image but abstractly.
That's how I think of almost everything "visual" - a scene has stuff going on but I don't see it, but I do sense it.
Conversely, I have an excellent sense of smell and can imagine smells, something a lot of people apparently have trouble doing.
I just don't think in words? Thought happens, but unless I'm "talking to myself" in my own head, it doesn't take the form of words.
At risk of being metronomic, do check out Blake Ross's essay on this -- he's a bright guy (Facebook director of product & Firefox cofounder, wrote the script for Silicon Valley S3E1 etc) who had nevertheless felt stupid a lot growing up because questions like "What did you do today?" completely stumped him; discovering that he was aphantasic (and that most people are not) clarified all this:
https://m.facebook.com/nt/screen/?params=%7B%22note_id%22%3A2862324277332876%7D&path=%2Fnotes%2Fnote%2F&refsrc=deprecated&_rdr
I lack internal monologue/dialog (seemingly, some of my sane-acting friends, have multiple voices in their head). I can talk to myself in my head, but it's forced. I use it basically only when thinking about social interactions - I'm autistic and somehow it's easiest way to understand some more complicated social situations.
My thoughts aren't easy to describe. When I'm thinking about math, there are unfolding images of equations. When I'm thinking about my job (software engineering), I see some kind of UML diagrams, and sometimes graphs. When I think about biology, it's graph of concepts. When I'm thinking about engineering or DIY, I just see schemas of objects.
Sometimes I just get answers - I think of question and after few seconds of nothing I get answer, but I don't know how I got it. Usually I can reverse-engineer that answer.
Impaired insight, common among autistic people, can play part in this.
I go back and forth between having an inner monologue and not. I do most of my important thinking nonverbally. I don't have any inner monologue when I'm taking a test of math or geometry or chemistry. I only need the inner monologue for doing verbal things.
I find that despite having a constant inner monologue, all my thinking is done non-verbally. The voice in my head is just constantly *composing* my thoughts into an explanation. My guess is that this is the case for everyone, to lesser and greater degrees of noticeability.
things that suppress my inner monologue:
* playing a game that requires intense focus
* taking a test that requires intense focus
* reading
* sex
* paying attention to music
* paying attention to audiobooks
* paying attention to anybody else talking
My brain can only process a maximum of one verbal stream at a time, and sometimes not even that when I'm overly occupied with other things.
Yeah that squares with my thinking (pun intended). I'm definitely not hearing my inner monologue while speaking, and usually I don't while reading or focusing either. But obviously you still have to think while talking! So the thinking and the auditory hallucination are two different things. I wonder how many other people are in the same in-between region you and I seem to be in
As a former mental health counselor and someone who has been in therapy myself, I see the value of a therapist. I also see value in friendships and meetup groups. The cost makes you sure you will get value from therapy. IE: "Why would you pay for something useless?" "Cognitive Dissonance" is when you do something, you want to believe it makes sense, so you change your thoughts to explain your actions. Some people know themselves better than others. Some realize the value in knowing themselves and want help doing it better. When the outside world tells you to be one way but internally you feel the opposite, I think therapy works. After all, the therapist is paid to be honest with you and so many other people selfishly tell you what you want to hear or what is best for them.
I think what it comes down to for many people is personality style and where on the scale of functional to dysfunctional they fall on for each style. If your traits in these areas (i.e. obsessive-compulsive, paranoid, hysterical, depressive, impulsive, etc.) do not reach the level of neurosis, basic self-help and behavioral activation will suffice. Once you reach the neurotic level where your cognitions or actions are negatively affecting your life in some way, it is probably more efficient for you to talk it out with a therapist, pastor, priest, rabbi, etc. Once psychosis comes into play, you will most likely need some kind of psychopharmacological intervention.
I imagine most people in the EA community would fall into the obsessive-compulsive style, which is selected for in high-pressure environments.
It feels like there is an additional major ingredient that wasn't mentioned here - the healthy relationship. It never ceases to shock me how many people lack basically consistent, supportive, and loving relationships, and how beneficial it can be to simply sit with a caring individual on a regular basis, remunerative or not. It's soothing to the nervous system; it's reassuring; it's (for many) a necessity that's otherwise unmet.
I've noticed recently that I've really enjoyed novels where all the major characters are basically friendly, and the protagonists don't have to constantly tolerate bullies or corruption or entitled brats or the other persistent assholes that drive the tension in so many other stories. I find it soothing to read a story where the point-of-view character knows that they're surrounded by reliably cooperative people.
Could be related to what you're talking about?
Makes sense to me - a similar desire for positive interactions with trustworthy, caring individuals. Everyone needs social safety and a feeling of being basically liked. Most of us didn't get it from our parents, of course. Harvard professor/Mahamudra master Dan Brown developed a visualization protocol for addressing attachment disruption and two of the five pillars are a sense of safety security, and a feeling of being genuinely liked: https://www.youtube.com/watch?v=z2au4jtL0O4&t=369s (10 mins, worth it)
Sounds great! Is there a novel of this sort that you would recommend?
Here's a couple stories that gave me this feeling:
One is "A Succession of Bad Days" and "Safely You Deliver" by Graydon Saunders (books #2 and #3 of the Commonweal series). A small group of people don't realize until adulthood that they have strong magical talents and need to be trained or their magic will kill them. All the students become friends, and all the teachers and civil servants they encounter are basically good people trying to do their jobs well. (I don't know WHY it's called "A Succession of Bad Days"; they pretty much succeed at everything they do.) These are available on the Google Play store.
Another is "Beware of Chicken" by Casualfarmer. A guy from our world gets portaled into a Chinese fantasy world where people cultivate qi and practice fantasy martial arts; he immediately decides to run away and become a farmer, whereupon he accidentally uplifts his farm animals by infusing them with qi. This is currently being published as a web serial on Royal Road, but supposedly the first chunk of it is soon to be released as an ebook. (If you prefer reading ebooks, the browser plugin WebToEpub can also suck the whole story off Royal Road for you.)
Thank you for the advices, I will check them :-)
I think This Used to be About Dungeons by Alexander Wales qualifies. It's a very chill story told from the point of view of five characters who originally get together to dungeon delve in a fairly utopic fantasy-ish world, but it ends up being about their lives more than the dungeons (as the title suggests). It is also a web serial being published on Royal Road.
https://www.royalroad.com/fiction/45534/this-used-to-be-about-dungeons
Thank you, it seems very promising indeed!
> I Want a New Show Like Star Trek: The Next Generation or Law & Order
> good people, working intelligently to solve complicated problems
https://freddiedeboer.substack.com/p/i-want-a-show-thats-the-baby-of-star?s=r
House MD? (Although the "good people" part might be questionable; Dr. House is a cynical asshole.)
L&O had good people? Didn't they spend most of their time figuring out how to get around a violation of the "perp's" civil rights?
I remember enjoying Stargate SG1 (the early seasons in particular) for exactly this reason. Intelligent ensemble cast, trying to do a good job under difficult circumstances that were (almost never) caused by interpersonal issues. Basically, professionals being professional! Person of Interest ticked a similar box for me despite being extremely different in tone. It's nice to see highly competent people who are also trying to be unselfishly good.
I have some good relationships but sometimes they are giving me problems because those people have problems and I cannot merely tell them to stop having their problems.
Maybe there is an easy answer. If I can pay $150 to get the easy answer, it is money well-spent.
Don't therapists also practice what I would call "strategic listening"? By that I mean they're trying to pick up details that would indicate a field-tested strategy for dealing with the person's problems? Ordinary friends wouldn't really have the same type of experience in that regard.
Therapy is about having a healthy relationship with a trusted person. That's often thought to be the reason why most mainstream schools of therapy are about equally effective—therapists will say they have different theories and techniques, but de facto what they DO in therapy is generally similar. And then, one theory for why therapy can work is that the patient develops a mental model of a trusted, knowledgeable person they can talk to or whose perspective shows up in their imagination when they have decisions to make.
Obviously all of this is super-idealized "how it should be" rather than how it is.
I had two sessions with a therapist about a year ago when I was terribly, terribly depressed and under-confident.
In the first, I explained to him that I wanted to quit my miserable law job that I was terrible at and do software design, which I obviously have a talent for. I explained that I had a lot of confidence in my ability to career switch, that I thought the transition would be successful, that I'd given it a lot of thought, but that I felt stuck in the law job. He responded (with the tact and grace that therapists have to use) "Uh, okay, so...do that?" And then I did, and it worked.
I had a second session a couple months later, having improved significantly and successfully made my career switch and he said (again, with much more tact than given here) "So...what else do you need then? Why are we still having sessions?"
On reflection, the first session was him giving me permission to get to a place where I didn't need permission to do things that were good ideas, and the second session was him saying "uh, dude, now that you know your own judgment is fine you don't need my permission to do things that are good ideas."
That seems very very silly in retrospect. I don't think he was particularly skilled at drawing out emotions or deep healing or whatever. He literally responded the way any sane person would to a person saying "Hi I'm unhappy and this would make me happy. Should I do this?"
But from inside a mind that was completely enveloped in self-doubt and depression, it would have been absolutely impossible for me to figure out that the best way to stop doing stuff that made me miserable was to just not do stuff that made me miserable anymore. So good job random dude. And kudos for not milking me for weekly therapy sessions for a year and a half. That was the secret sauce.
I've had anxiety/depression for as long as I can remember, and therapy didn't do anything for me. The therapists were very nice and I went to plenty of sessions, but I don't remember any effects at all. Maybe because they didn't have anything new to tell me that I hadn't already thought of?
Meanwhile, meditation has been working extremely well for me. I feel like the anxiety dials itself down from 5/10 to 2/10, and my psychosomatic pain goes from 3/10 to 1/10. But then it comes right back the moment life interrupts my ability to meditate daily without being sleepy (another victim of Daylight Savings time).
This.
Keeping up with meditation (waking up in my case) also at some point made me get the whole cbt thing (which previously I thought was mostly nonsense).
Like with therapists, which program will suit you may well differ.
And some people are *too* good at having conversations with themselves, they ruminate and reinforce unhelpful and inaccurate views about the world and other people. Bouncing the thoughts off someone else gives a chance to interrupt the death spiral.
It seems true to me that therapists are making up for something lacking in people's conversations with themselves, but you'd have to be a rationalist saint to not be lacking in any of these ways. People aren't instinctively introspective, and lots of obvious things aren't obvious until someone points them out to you explicitly. Remember your story about the person who had no sense of smell, and explained the whole thing to themselves as a metaphor, instead of realising everyone was experiencing something they weren't? That's the human brain doing what it does best: explaining instead of noticing.
There's also the fact that big risks are both irrational and a part of life: Because you evaluate new ideas in a way that you don't evaluate the status quo, it is very very easy for a person trying to make a rational decision to argue that literally everything should remain the way it is forever. I certainly have an overactive inner monologue and can successfully argue myself out of doing anything interesting ever.
Was going to say something similar, I went through a period of depressive self-loathing and my experience with therapy was less about finding someone to talk with and more about finding someone who could tell me that actually, no, I wasn't objectively a terrible garbage person (and who could understand the monologue playing on repeat inside my head well enough to point it out to me in a way that allowed me to question it).
True, a lot of people have pathological inner monologues. I don't think it is a matter of being "too good" at it but more of their monologues being unhelpful instead of clarifying.
I'm surprised that this discussion doesn't include interpersonal dynamics as a success dimension.
I have been to a few phycologists in my day, and honestly none of them were all that helpful to me in the aggregate.
However, there were a couple (literally two) times where a therapist would toss out a key phrase or an observation that seemed to instantly unlock a door in my mind and give me a new way to think about things.
The chances of me striking gold again would appear to be rare, but I'd be willing to go digging for gold if I knew how to identify the right person to invest my time with.
Ultimately, it seems to me that finding just the right person to discuss your distinctive set of circumstances with is perhaps the most important variable in ascertaining therapy efficacy.
That was my case as well. I learned a lot of things regarding how my psychology functions from professionals.
It might also just be helpful to hear perhaps obvious truths said by someone you've imbued (rightly or wrongly) with authority to say something. The power of "have you tried this" isn't just high if the "this" is some deep insight.
I also think for many folks I know they a) either find this uncomfortable to do by themselves, b) don't have peer groups they'd trust to say it to incl spouses, and c) this becomes a ritual and rituals are comforting and helpful even if it's a placebo.
I'd wonder which of this,if any, Scott finds in his practice too.
Anecdotally, one of my best friends finds therapy completely ineffective, but she is also constantly thinking about her own problems. Versus me who has found therapy immensely helpful, as someone who finds self-analysis difficult to deal with
Predictive processing seems to suggest that most of us are living inside of something like 'cartoons.' _Especially_ in the area of "what happens inside other people's heads", because there's so little feedback from reality there. So maybe this is why some people's internal experiences seem so weird and out there to others?
I've been seeing the job of a therapist (or the coach I see), as something like 'increase the resolution of my cartoon so that it matches reality a little better. I suspect that trapped priors play a big role here. For example, I see an attitude coach, and our conversations are probably _extremely compressible_. "You don't need to expect yourself to be perfect" is the kind of thing that i've repeated to myself over and over and over and over and over, and i'm sure glad there's somebody i can pay who consistently notices when i'm acting in a way that suggests i expect perfection from myself.
A bit off topic, but this morning I read for the second time "Good Old Neon" by David Foster Wallace. One of the themes is the relationship between the narrator and his therapist. You feel sorry for the therapist in a "Good Will Hunting" therapy scenes way( before Will gets to Robin Williams). It's a brilliant and powerful piece of writing that should not be read if one is in a depressive state.
I am pretty sure most people would benefit from therapy in a wider sense, i.e. structured self reflection with the help of a trained person. Unfortunately I learned that only after my divorce and after I hit many walls with my rationality.
However, I am also convinced that talk-focused therapy is not the best way for many rational people. Body oriented therapy forms, including and especially intense breathworks seem to work better with mind-focused people. And - yes - psychedelics in the right setting
Why would *most* people benefit though, that's the question.
Because I agree with the statement that "everyone is defective in some sort of basic human functioning" even though I wouldn't use the word defective. But everyone has blind spots, and it helps to know these and make them visible
This is a pessimistic thing to believe. Do you think everyone is defective in some biological (i.e. somatic) way too? If not, what makes the mind especially defective?
It's just my experience with people, and I said that I wouldn't use the word defective. Think of therapy like the things you do to keep your body healthy - from dental checkups to doctor visits - totally normal to do from time to time
Instead of defective, we could say "not trained to be skillful."
I seem to remember Scott mentioning previously that CBT was originally very effective and now is shown to be less effective, and one theory for that is that everyone gets small doses of CBT from society and their relationships and they have already reaped a portion of the benefit, so there is less to gain when they are exposed to it in a clinical setting.
So we could easily be in a situation where most people could benefit greatly from therapy 40 years ago and now a smaller subset of them would receive a similar level of benefit today because they are getting their therapy from the community.
I somewhat agree with your statement but would put it differently: Today, the spectrum of therapeutic settings is much bigger than it was 40 years ago. You have therapeutic breathworks classes,retreats of various kinds, and much more. So going to a talk therapy fortunately is no longer the only options. Chemicals that help some people, from CBD to 5HTP to psychedelics add to this spectrum
Imagine a new modality that 100% cures about 15% of the people who try it. Imagine its so brand new only a few hundred therapists practice it. Now, imagine that a potential patient can hear it described and determine with a high degree of accuracy if it will work for them based on an initial gut reaction.
Solve, as they say, for the equilibrium.
You get an initial rapid uptake in adoption, where all those self-identified high-responders go after it and find a great response. And wozers, look how well it works for everyone. Then, low-responders get convinced to give it a try even thought their gut (accuratly) says its stupid. You'd see this exact phenomenon you're describing.
I don't know the numbers, but this is exactly the process by which most successful inteventions work in both talk therapy and health-and-wellness. People who hear about CBT and think it sounds good have great results if they stick to it. People who hear about couch-to-5k and think it sounds good have great results if they stick to it. I tried couch-to-5k once even though I hate running, and it sucked and I gave up. My physical therapist said "You can live the rest of your life without running a single step, if you want" and I said "huh, he's right" and now I just do strongman shit in my garage and it works great.
I would argue that therapy is optimized to provide the perception of value. In much the same way that being aware of a systematic bias doesn't make you immune to it, people come out of therapy with some profound realization about themselves and then don't do anything differently.
I'm not necessarily saying therapy isn't effective, but self report is basically useless here. There are no counterfactuals, and outcomes are poorly measured.
Outcomes are poorly measured for sure. But also, the point of therapy most often is to reduce a person's suffering, which is a subjective experience entirely distinct from one's life circumstances. Sometimes doing something differently is essential to reducing suffering and very often it's not. See also Buddhism.
I was introduced to the idea of therapy more as a check on one's inner monologue, rather than as a substitute for its absence. In my experience, therapy was a helpful way to escape the destructive framing sometimes provided through introspection alone. In that respect, it doesn't feel too different from exercising principles of rationality, like rooting out cognitive biases, clearly stating assumptions, reflecting charitably, and showing your work.
The first time that a differentiation of different types of therapy made sense to me was in the book summary by Kaj Sotala of "Unlocking the Emotional Brain". There was a graphic included (at least in the print version) that described behavior therapy and emotion focused therapy as targeting emotional responses, psychotherapy targeting episodic memory, and Cognitive behavior therapy as targeting semantic structures.
I don't know how well this description meshes with either practitioners or patients. I also don't know anything about "supportive therapy". Is that the same as what I've heard referred to as "talk therapy" or is there a nuance I'm missing?
I'm wading into this discussion as a pretty blank slate without many preconceptions or background knowledge, so please forgive me if I'm framing this poorly.
(Edited to make it less ambiguous that the book summary was by Kaj Sotala instead of the book itself).
Are there really people who have no inner monologue?
Yes. They are surprised to hear the rest of us have one!
Seconding curiosity about this. In particular - how would we know? How could we rule out a difference in language used to describe internal experience, vs. a difference in the experiences themselves? I trust that some people have done their homework and it's actually true. But I'd love to see the receipts.
There must be studies.
There are studies for everything and its contrary. I'm wondering if there are GOOD ones.
I've looked into this a bit more for phantasic processing, but there are similar MRI studies for inner monologues.
This one looks decent: https://www.frontiersin.org/articles/10.3389/fpsyg.2014.01393/full
Basically it compares people's self-perception (using the "DES method") of inner speech against the speech parts of their brain activating in the MRI scanner. And the two were reliably linked.
Also: Worth knowing on this topic that there are two kinds of inner voices - the one in the study above reflects the kind of most people's inner voices which is "articulatory". The inner voice feels a bit like you about to speak, but you're not speaking.
People also have "auditory" inner voices, which are imagining audio of voices. So that is imagining you are hearing something. That voice can vary richly in tone and accent if somebody has a good audio imagination. It could sound like your own voice, or other people's voices, and this gets used in an extremely varied number of ways.
Ah thinking back, I guess you're asking for a paper which has taken someone who says they don't have an inner voice, and their speech centre hasn't fired over a decent length period. So yes, which studies are good and cover that well is your real question...
I mean it’s definitely clear to people who have interval monologues that they have them, right? Or that we can visualise things, which people with aphanasia cannot. There are apparently tests, but self reporting would be reasonably accurate regardless.
I believe an "inner monologue" is just the verbalization of things that you've heard, yet not had the chance to say out loud. See also: The chants of children in the schoolyard.
It’s not what we have heard, except for music but the ear worm effect seems like a different part of the brain. It’s conversations with ourselves or others.
Funny enough the idea of meditation is to quieten the inner voice, so those of you without it may be zen already.
I have a feeling that "lacking an inner monologue" is a self-serving way of accusing people who've reached zen state with having some sort of non-decipherable disability. But hey, you can't blame 'em, those zen monks speak in koans.
I honestly don’t know if I have an inner monologue or not. Does that mean I probably don’t have one? As in, for people with strong (loud?) inner monologues, is the fact of their existence impossible to ignore?
They vary hugely in strength and personality, and what they talk about and when they speak, between people. Also they can be articulatory (like you're about to speak) or auditory (imagined audio).
I think it is probably possible to have a weak one and not realise. I have a very weak visual imagination, and didn't count the weak thought forms (some spatial relationships, some colours) as "visual" when other people were describing seeing whole scenes like a movie when reading a book.
Similarly, it is possible you have some kind of inner monologue but it is weak.
Most people though seem to have an inner monologue, and if you ask them know what it is saying, and could somewhat recite it.
Thinking about my own, when and how I have one and what it is like does vary hugely over time. It is also hard to talk about, as the act of talking uses the same part of the brain as the monologue, so stops it.
If all the content of your thoughts were transcribed to paper chronologically, would it result in an easily interpretable string of natural language? If yes, then you have an inner monologue.
Isn't "easily interpretable" relative? I have an inner-monologue, and it feels understandable to me, but I don't voice them to the general public because I've had bad experiences in the past with doing stuff like that. Maybe an inner-monologue is a function of how readily your ideas are accepted by society.
Whether the ideas expressed in your inner monologue are understandable is irrelevant to whether you *have* an inner monologue. I specify that because some people might think in words, but not in sentences.
To even start defining the "inner monologue" as something that is either words OR sentences completely disregards those people who speak and/or think in languages that don't function with the same grammatical framework that English does. Your understanding of what is or isn't *understandable* already prevents you (and pretty much everyone else trying to tackle this problem) from understanding the nature of the inner monologue.
What? The question was "how do I know if I have an inner monologue or not?" and the answer lies in how much of your thoughts are expressed in language. What does the grammatical framework have to do with that? Language is used to communicate between people, so *by definition* it has to be understandable.
I do not have one. I "talk in my head" almost only when I am rehearsing a conservation that I am planning to have. I sometimes think that I should work on having a much more frequent inner monologue, because I have the impression that lacking one is making sometimes ignoring obvious things, but at the same time I feel that having an internal monologue would slows down my thoughts...
When you reherase the conversation, do you talk in your head with both sides of the conversation, so the other person as well?
And do you hear different accents and tones?
My guess is you have an audio imagination, and use that for rehearsing a conversation. Which is a kind of inner monologue!
Quite different from the more common articulatory one (like you're about to speak but aren't speaking) which lots of people partially narate / think through their lives with.
"(like you're about to speak but aren't speaking) which lots of people partially narate / think through their lives with."
That is what I am doing when rehearsing a conversation but I am almost never doing it (at least consciously...) otherwise. For example I almost never narate my plans for the day, or my opinion of someone, etc. My thoughts are usually a jumble of emotions, concepts, music, etc.. but very few words or sentences.
I wonder, do the different "thoughts" and or "voices" and or "voiced thoughts" have different accents, or ways of speaking? You may be experiencing what Freud (or some other equally german psychologist) calls introjection, when you internalize someone else's voice that you've heard.
Hear also: The Voices of Ancestral Spirits (or your parents, or other such authority figures)
To me the distinctive thing about therapists is that they are:
1) Pretty intelligent people
2) Who are paid to help you
3) But who are willing to offend you in ways friends/family might not be.
As a consequence, you can talk to them about stuff that would otherwise be taboo for you. If you're full of shit, they'll tell you. If not, that gives you permission to explore new sets of ideas. I think people generally underestimate how much of what's in their heads are the same thoughts that have been swirling around, unexpressed, for years.
People can be resistant to expressing those thoughts, which is why it can take a few sessions to make a "breakthrough".
Those breakthroughs are what's behind those people (including me) who have gotten extremely high ROI out of just a few sessions.
The rest I think is just life coaching by another name.
...Are they actually intelligent though? Have you looked into this?
I suppose they're smart enough to get the relevant qualifications, which is good enough for me
I honestly believe that a vast majority of therapists would never tell a patient they're full of shit.
It sounds reasonable that many people will benefit from having someone to just sit quietly and listen to them talk about their problems. The act of explaining your problems helps you think about them.
But if the main skill is sitting quietly, why do therapists make a couple of hundred bucks an hour? Where are the minimum-wage therapists? An Uber driver can sit quietly and listen to people talk about rubbish for hours, if you take away the fuel costs he'd be a lot cheaper.
Heck, even if you insist on credentialism there's a helluva lot of psychology graduates who can't get a job in their field; give them a two-hour crash course in "sit quietly and listen" and let them charge thirty bucks an hour, they'll be happy.
Because it is important for them to have enough prestige for you to trust them. Lower-wage versions include priests, community leaders, grandma, etc. with varying levels of skill and/or being paid by other means.
I deliberately sought out a high-status male for my son for therapy because the prestige was important to make my son listen.
Traditionally, a low-wage therapist is called a bartender. ;)
I think some degree of safety is guaranteed (or at least can be litigated over). Imagine you were telling your uber driver about an embarrassing story, and then he laughed at the end, making the trauma worse. You take that risk by telling it to your uber driver. With your therapist, you assumedly aren’t
My experience with psychologists is that the majority are there to listen to and soothe the anxieties of well off people without deep problems. Or to be used as internal weapons in behind doors struggles.
Of course, there are many that are not. Some deal with people with deep trauma or real mental issues. But your average therapist in an office in suburbia is mostly there to get paid by a husband to make his vaguely disatisfied wife feel less vaguely disatisfied. (I've also seen therapists who are effectively used like weapons. One therapist in Mass. had a good reputation as always siding with the woman and so was popular with a certain type of wife or daughter.)
The issue is these two get mixed up. Someone spends their entire career convincing wives that yes, gosh darn it, it IS meaningful that your husband didn't put the toilet seat down. Or husbands that yes, they're not Fabio but their wife still loves them. And then someone walks in with PTSD or deep complex trauma and they think they can handle it. But they can't and they just run out the clock on sessions accomplishing nothing.
There are no doubt therapists who could help these hard cases. But there's no meaningful way (from my point of view) of determining which is which.
Didn't you just point it out yourself? Look at their clientele. If Dr. Schmo works at the VA and 85% of his clients are Iraq and Afghanistan vets, he will at the least certainly not wig out when confronted with a serious PTSD issue. Likewise if Dr. Foo has a tony office in Beverly Hills with a load of cat posters on his wall and the waiting room is filled with middle-aged women with $40,000 earrings and Botox everywhere, you might want to reconsider whether this is the right person to deal with the nightmares you've been having about the rape.
Client lists are confidential and all of them will say they deal with hard cases and you can't verify. I don't have access to the VA either.
Ah OK, I misunderstood. I was interpreting you as saying there are no ways, but what you are saying is that what ways there are are not practical. Do therapists really false advertise like this? Seems ultimately self-defeating. I mean, if I tell someone I can fix their lawn mower and I actually have zero relevant experience, I'm setting myself up for an embarassing failure.
Yep. I'm not saying it's literally impossible. But it's not done or at least I've never encountered it. I expect set up costs for a client are pretty cheap. It's just a booking. If it's $100 a session and I come in three times they've made $300. Plus there's a list of excuses as long as your arm about why it's not working or you need a few more sessions. I've had some very bad experiences. Even with people who supposedly specialize in deep traumas.
Bummer. You'd think the guild would do a better job of self-policing, in the interests of the image of the better/senior members, but oh well. I'm pretty confident *among themselves* they are pretty clear about who's a rockstar and who's a charlatan, but it doesn't seem to go outside the lodge walls, more's the pity.
"There are no doubt therapists who could help these hard cases. But there's no meaningful way (from my point of view) of determining which is which."
Really? There's absolutely nothing that gives an indication of which psychologists deal with hard cases and which are for rich housewives?
I'm curious what your idea is. Carl's was "ask them to violate HIPAA by telling you their client lists" which doesn't seem all that promising.
Come, they needn't violate HIPAA to characterize their clientele generally. They could even literally give you a redacted client list -- this many cases of ADHD, this many cases of marital discord. And I guess I would have naively expected them to do so pretty openly, in their own self-interest of achieving good success rates. But maybe they don't! I suppose emotional advice could be a field as rife with hucksterism as financial advice, more's the pity.
HIPAA is pretty strict liability. They can anonymize the data and pass it off. But if someone figures out how to trace any of it back to a specific person they're liable. I've never seen it offered and when I ask things like how many cases of X or if they have any Y as clients they've usually given vague answers. "How many depressives have you dealt with?" "Well, I can't tell you exactly, but many."
That's just fucking lazy. Good thing I'm not a member of the profession, so I don't have to be embarassed. I wonder if it's some kind of weird trust issue, like they're thinking "If you don't come in with some kind of quasi-religious faith that I can help, I won't be able to help?" Or maybe it's a hazing ritual, like if I can get you to accept this thing on pure faith, then it's a good sign I can get you to do all kinds of later things (during therapy) on faith, without having to argue out every point (which would be tedious and counter-productive I agree).
Either way, it wouldn't suit me at all. I would definitely be in the mindset like I'm *hiring* you to help me, like I'd hire a plumber to fix my drains, and neither of us should be embarassed if I ask for some proof during the hiring process that you have done this kind of work before with success, that's just good business sense.
I guess I would have trouble finding a therapist :)
If I had to guess, I think it's simply due to the fact that "guys want to be cool by not wearing jackets when it's cold."
I think the rationality community is very apprehensive about attributing common problems (for people like ourselves) to our relationships that we've had with broader hierarchical structures in society.
For example, a guy would (if he had been raised on that island that that king thought about once) if he felt cold, put on a jacket (or at least, fashion himself a jacket out of palm fronds or something I've never been on that island).
But seeing as how we don't live on that archipelago Scott's been looking for his entire life (and I'm also here to tell you that that archipelago is The Philippines) guys will have the following thought process:
-I am cold. I must put on a jack--
-Wait no then I wouldn't look cool I mean I don't need a jacket, jackets are for people who are weak (or at least, don't like the cold I mean can't handle the cold...)
Notice how disjunctured that is? Yet I bet that it's real fuckin' familiar to a lot of you reading this.
If I had to make a guess, it would have to do with the difference between how girls and guys perceive the cold, and where in the societal hierarchy they see themselves.
A guy with a fear of not finding a mate would do all he can to prove that he's the toughest (i.e. not wearing a jacket). Obviously this is a problem, but why? What is the source of it?
Because we all know that a "sensible person" wouldn't care about "trying to look cool", and so they would instantly put on a jacket (or fashion one out of beautiful banana leaves, right here in the Philippines!)
But the only people who would do that are people who don't understand just how high in the social hierarchy they already are, and so feel no need to prove to the cold that he's better than it.
On the other hand, the guys not wearing their jackets their mothers made and/or were handed down from their older brothers, who might have internalized a feeling of being "low on the totem pole" (which by the way, don't exist in the Philippines), or guys who were generally unattractive or ugly (or any sort of reason such kinds of people would like to insert for yourself here), would try their hardest not to think that the reason they were trying to not put on their jacket was because "I'm a real man!".
If you don't believe me, go ask a girl what she does when she feels cold.
And also, read Sadly, Porn again, but this time, don't skip over those blocks of text you think you're better than. That's where the secret to this lies, you skimmers.
Maybe we just like the freedom of movement and feeling light more than we hate the cold.
Also, there are jackets that look cool.
And thus, I recommend the Philippines for anyone like you (I wanna look cool, have freedom of movement, and feel light too y'know).
'Cause the only place to be all of those things without having a jacket is some warm temperate climate. The archipelago stuff is just for if you're one of those TRUE rationalists.
No way. Walking around in 2 feet of snow in Wisconson swinging an axe and being so hot you need to roll up your flannel shirt sleeves is hella cool. At least I assume, I've only did the walking around in 2 feet of snow in Wisconson part, but I have to immagine if I some some burly dude splitting frozen wood like that I'd think its hella cool.
I'm very sorry you think Edward Teach has anything meaningful to say. beyond "I think I am the only adult on the face of the Earth and desperately need you to know it." Yes, I am an evil narcissist who doesn't desire anything except to deny other people their desires. Yes, yes, Lacan is right about absolutely everything. Despite all these things you know about me- even when I'm interested in going on a date, I wear a comfortable jacket. This is because I don't like being cold and couldn't give less of a piss about whether someone sees me as "lame" for wearing a jacket. Someone who sees other people as "lame" for wearing jackets isn't someone I'm interested in dating to start with.
Hey with that kinda logic, you don't even need a jacket! You just need to misunderstand enough analogies till you're filled with hot air!
Yes, yes, I'm too stupid to REALLY understand Sadly, Porn too. Poor Cro-Magnon me actually assumed someone SAID what they MEANT instead of engaging in triple-reverse-corkscrew psychology with a side of moon logic to derive the secret TRUE meaning from it.
Please, for a single moment, imagine a non-Filipino person might be driven by something besides facile status games.
Νο, maybe just phallus status games. But even then, the Filipinos are great at that too! (See also: the rates of homosexuality and Catholicism in the Philippines.)
I have never tried therapy, but there have definitely been instances where I had a personal problem and after much consternation either said to myself or had someone say to me "dude, why don't you just [really obvious solution that simply never occurred to me]?"
In our society, there seems to be very little formal development on how to understand oneself, others, and the world. Meanwhile, informal development is provided by family (with a huge variance in amount and quality) and society (which today means navigating hundreds/thousands of competing narratives). As such, there may be quite a few people still at very early stages of development when it comes to things like emotional intelligence. Therapy is a form of such development (at varying levels of quality).
To give an example that can maybe spur discussion: what makes the golden rule so golden in our society? I view it as a developmentally infantile and self-centered approach to understanding interpersonal relationships. "Do unto others as you would others do unto you." This requires giving absolutely no thought, modeling, or sensitivity to the mental states of others and yet it's often used as a paragon for interpersonal behavior.
On the one hand, something like "try to understand Jimmy's mind-set" seems like low-hanging fruit. On the other hand, I'm not sure that 95%+ of the population has ever been given any tools "to understand Jimmy's mindset".
My wife and I were wondering if it was always like this, or if we are living in an especially inept era. Perhaps in simpler societies, where there is high default sharing of values and behaviors, default emotional IQ is higher. I wonder if therapy is more or less necessary in such places.
I only know the local situation in Czechia and I can say that there is zero formal development. I personally think that this really sucks, because knowing your cognition, body, how to communicate and relate, that is utterly essential for your life. Actually without being told how to decide and orient yourself in the world, you will probably just spend the whole life tripping on various narratives, and that is like running on the mine field. People want to have the freedom to do whatever stupid shit they want and feel like, but nobody wants the responsibility for all the obviously bad decisions you were even told about in the first place. This is just blocking all progress IMO.
Regarding EQ, when you go to a psychologist, they will probably tell you about a version for kids, i.e. regular people, which is just yet another schema. I really feel like crying when I see how people know absolutely nothing. So much extra suffering.
Of course I can't help myself because I'm a therapist... a few random thoughts.
One is, I too have my own questions and doubts about aspects of my profession. I won't go on about those here, I'd have to start my own substack for that. All to say I'm not a cheerleader for my profession, but there are some aspects of its use that are not too hard to understand or communicate, I think.
You're not wrong in saying that many people go to therapy to get help with defective, deluded, distorted aspects of their thinking that are hanging them up in their lives. We do all have these aspects to us. That can work fine for long periods of time or in many circumstances, until we get thrown some curve balls of particular kinds and then our normal, human distorted thinking habits can cause us a lot of trouble. So...
The kind of people i see getting help with certain kinds of therapy:
* survivor of trauma, whether sexual assault or violent crime or natural disaster, etc. Your average friend or family member is not well disposed to handle traumatic material relayed to them, so friends and family can be of limited use sometimes initially, depending on the disposition of said friends and family. Debriefing traumatic experiences in a structured way can help a person recover and/or head off more lasting problems. Friends and family are essential though in addition, and I would say that for all these situations here...
* person going through a stressful thing and needing a safe place away from stressful thing to consider how to respond to stressful thing: divorce, terrible medical diagnosis, considering the end of a long relationship, considering a career change, bullying at work or school, heading towards retirement, recently relocated and without local social supports, adjusting to having kids or becoming a blended family, losing a child, and so on. There are so many circumstances like this where a basically healthy and mentally sound person just needs a grownup to talk to so they can sort through all the various feelings and thoughts, and often conflicting priorities. To basically listen for their signal in all the noise of the event. This is more like coaching, but is not reducible to supportive therapy, and often people's default modes hang them up in these moments so that something well beyond supportive listening and coaching is needed for them to navigate the change life is demanding of them.
* person in young adulthood -- say until age 45 (only sort of kidding) -- who experienced various kinds of emotional neglect (from quite benign to really malignant) and therefore failed to develop a sturdy inner guidance system. Mildly shitty or narcissistic parenting can leave a person constantly looking over their shoulder, paralyzed by all kinds of self-sabotaging habits, or just unable to identify and name their own internal experience or what they might want to guide them through life. Your writing above seems to suggest you underestimate how common this is and how impairing it can be. This person often has trouble attracting and forming close friendships with people who are wise and stable, and so they do not have in either friends or family the kind of steady other person to help them solidify a sense of self as distinct from all the bullshit they internalized growing up. Short or long-term psychodynamic, among other approaches.
* person who is trapped in long-standing cognitive patterns that feed their natural inclinations towards anxiety or depression. CBT, exposure therapy, mindfulness, etc.
* person who has developed behavioral habits to try to self-treat their underlying anxiety, depression, trauma, etc -- addictions, compulsions -- that have grown into their own additional sources of impairment. They may need a mix of all the things above depending on what's driving the behavioral compulsions.
* some people are external processors, as you suggest, and regardless of how nice their family and friends are, they need more time and audience during stressful life periods in order to hear themselves think. Sometimes these people want to talk about things that they don't feel they can share with their friends or family. Coaching, CBT, ACT, etc.
* some people face existential fear or existential predicaments that they likewise need a trusted other to talk through in the way one might have used a priest in a prior era. This work can be quite deep and rewarding and definitely isn't just supportive.
There must be therapists out there who only do "supportive therapy" but my understanding is that that's an expression more used to describe specific sessions here or there. "Client was highly distressed at news of mother's cancer diagnosis; intervention this session was mainly supportive." In other words, there are times in the course of therapy that the most appropriate response by the therapist is simply support, but that doesn't constitute the whole of a treatment plan. A person comes to you thinking they may want a divorce... after some sessions, they show up saying they told their spouse and now the separation is in process, and it's clear the job of that session is just to catch the grief or fear the person is experiencing at having made this choice and acted on it.
Otherwise, I think even the most in-the-moment therapists are operating at multiple levels of planfulness in terms of what they think they're doing with a client at any given time. I mean, of course YMMV. But the idea that it's a sea of "supportive therapy" out there seems inaccurate to me. The training, of whatever school, is definitely not mainly "oh, that must be hard" and nodding sympathetically. The entire arena of case conceptualization is aimed at helping therapists and clients come up with a reasonable story about what they are doing together and towards what ends, and to check in on that along the way. I have that case conceptualization in my head every time I meet with all of my clients -- and I don't work from any single modality so I'm not implementing any kind of manualized procedure on people.
Having said that, there are for sure clients who just want someone to talk to every week or every other week about whatever the hell happened for them that week. In my whole practice, I have a couple of people like that. It's pretty clear to me that my work with them is to address very entrenched personality adaptations to really significant trauma, and the stuff of their daily life is the arena of practice -- literally, how to have healthy friendships, how to set normal boundaries, how to self-soothe, how to name one's emotions and not have to act on them, how to allow oneself any amount of pleasure, how to make decisions towards one's own benefit, how to advocate for one's needs in multiple situations. That work can go on for years, and it is slow, but it absolutely yields improvement in that person's functioning every single year. I wouldn't be able to do it any amount otherwise, because I'm an impatient person.
Quite apart from the kinds of "clinical skills" that these above situations may entail, my experience generally is that most people are not great listeners. Our own narcissistic stuff enters so quickly into conversations with loved ones. Also, so many people are made very uncomfortable by other people's difficult feelings, so that support from one's friends and family runs into pretty hard limitations (minimizing, deflecting, fixing, etc) when one is faced with genuinely tough situations.
So, for what that's worth.
Thank you, thank you, thank you, thank you. I am *extremely* appreciative for everything you've written here with emphasis on your third bullet point, especially "Your writing above seems to suggest you underestimate how common this is and how impairing it can be."
No, rationality is not the be all and end all and it will absolutely not be sufficient to help many people with the sorts of troubles they are facing in their lives and relationships. I am stunned and disheartened to read this post and the comments. It leaves me despairing for the state of our humanity.
Great reply, one showing much more nuance regarding the field than most responses here (of course consistent with the fact that you are a therapist). As someone who has tried a fair amount of therapy, I would add that the quality of therapists varies dramatically. I'd say 8/10 are worthless, 1/10 may provide modest value, and 1/10 is extremely valuable, perhaps corresponding to the 1/10 who has mastered the various approaches outlined in your bullet points above. In my experience traditional credentialing and licensing systems provide essentially no information on whether or not a particular therapist will be valuable or not, so one has to find networks of trusted friends to recommend the good ones. I see much of the negative perception regarding therapy as due to the fact that most are, in fact, worthless. But simply because our credentialing and licensing systems are failing to provide any relevant guarantee of quality does not imply that all such practitioners provide no value.
My hunch is that really good therapists can help most people but that some people are looking for very specific things, or think they need very specific things, and that makes finding a good match pretty hard. And of course some of it is just chemistry, which matters because it's a much more intimate relationship than one has with many other people in one's life, and trust is so central to it. It's a common experience as a therapist to have clients say, "I've never talked about this with anyone else in my whole life," including from clients with very close, long-term relationships.
I've also been a client in therapy many times and I know I can be pretty fussy about what I'm looking for in a therapist, though not fussy in the same way as some other people I know, so I'm aware we can be fussy in very different ways that would lead one therapist to go right to the top of one person's list and right to the bottom of another person's. So that makes it hard to talk entirely about "good" therapists and "bad" therapists.
One of the things I think about a lot is what can be communicated fairly quickly at the beginning of therapy to help clients make good use of therapy. Some people come in ready to get down to work and able to make good use of the time and the therapist while other people can spend a huge amount of time (and money) just kind of spinning in default mode (I know because I did it for years as a younger person). A lot of this has to do with how the person's defenses are organized, how self-aware they are coming in, and how open to learning they are.
Many people who go to therapy have the idea that it's like getting a massage, which is fine if that's what the client and therapist want to do. Like "Where is it tight this week? Ah, over here on the left side of your neck, we'll work on that today."
For anxious people, this can look like them bringing in a different worry every week and the client and therapist talking about the content of that particular worry, doing CBT on that worry, identifying the distortion or proposing a practice to deal with it or whatever. The therapist is always doing some version of reassurance and problem-solving at the content level. But there is NO END of things an anxious person will worry about and there will be a fresh worry every single week (or more of the same old worry in slightly new clothes).
And I do think it's a disservice to clients not to say to them, "Hey, we're not here to comfort this week's worried thoughts; I'm not a crutch to help you get through daily life. This is a learning process where you go away with new capabilities to relate to your content." Therapy is intended to help a person relate to their thoughts and feelings, differently, which requires that they begin to pay attention to them at a more meta level, and that they stop investing so much reality in the content-level stuff. Many people have a lot of trouble doing that and their whole lives are basically always lived at the content level, reacting to the bumps in the road as they happen. Their default mode encounters fresh content week after week, but without the capacity to turn and look at the workings of the default mode, to increase awareness about how they relate to their experience overall.
Anyway, really high up on my list of what makes a good therapist is can they help a person investigate the workings of their default mode and do they have the skills to help that person figure out where to take it from there (and for each client the "from there" is going to look somewhat different, so there's no manual to follow).
And yes, totally, what you say about how bad the information is to help potential clients figure out what kind of therapist might help them. There are so many things broken about that part. There are so many fads in therapy -- CBT, ACT, MBCT, EMDR, IFS, MI, body-based therapies, blah blah blah, every twenty years a whole host of new clever acronyms that don't really amount to a hill of beans, but lots of insecure therapists chasing the next great thing (or building their trademarked empire on it). And then you have people's doctors saying, "go find a therapist who only does cognitive behavioral therapy because everything else is a waste of time." And that's nonsense as well.
If a client comes my way saying "my doctor said I need a therapist who does CBT" I'm likely to decline that client, as will most of the more seasoned therapists I know. It would take a lot more words to explain why, but it points to one of many disconnects in the process of a person navigating this whole mess of a system. Word of mouth is often the best way.
A gem in an otherwise strange sea of comments. Thank you for this.
How is it that in a rational community dichotomies are entertained? Is it this way or that way for all? Or this way or that way for an individual? Given I've found these two approaches completely unreliable and crazy-making, I'm going with "What types of therapies are useful for any one personal are individual and extremely custom, and therefore rolling that up to the masses, as public health has to in this case, any public heath recommendation should not be followed blindly by an individual. Same caution for root-cause analysis - there are usually more than one cause for complex issues. Sure one may seem like the root, but resolving it may not in fact resolve the problematic outcome. Oh, how I wish the many doctors I've had over the years were more systemic thinkers.
The way that I would put it is that people think the purpose of therapy is INVESTIGATION when in fact the purpose is CONFIRMATION - and confirmation is hugely valuable, at times.
Thanks for confirming that fact I thought myself first before reading your comment. Maybe the real psychiatrists that people should be looking for are people who claim to be time-travelers.
Exactly. If we feel we're being gaslit or misunderstood by certain actors in our lives, having an impartial witness to validate our intuitions (or contradict them even!) can be the reality check we need but can't get elsewhere.
This seems to be more of (but of course not exclusively) a woman thing. Hence the old idea that when a woman complains about something to a man (and the complaint isn't related to the man's behavior), the man will offer solutions to the issue, but the correct response is actually for him to tell her that she's right to feel aggrieved and that what happened to her is a true injustice (or words to that effect).
Well, one can sympathize with someone's upsetting experience while not necessarily confirming they were in the right. Sometimes just offering comfort is the gateway to then gently helping them see what their own responsibility was in the matter. Any good listener, especially a therapist, should understand that.
Are you trying to be funny?
There are very strong norms in culture, and when your experience is the against the norm, its hard to define and get recognition for it.
I have written this before. I tried classical Freudian therapy for my depression. Years later I tried Zoloft. The Zoloft worked. The downside of the Zoloft was weight gain. Freudian therapy didn't cause weight gain, and it didn't alleviate my depression.
Best benefit of therapy is having an adult to talk with.
Lots of therapists fail at that, though.
Possibly a stupid question: Has anyone made a serious attempt to construct a _list_ of all of these fundamental skills that most people have but a few people are randomly missing?
If that's knowable, but not currently known, it sounds to me like figuring that out would be worthy of being some brilliant scientist's life's work.
I know that professionals who work with developmentally-challenged people have some sort of list of milestones they use to approximate a patient's developmental progress/"age", which seems like it might overlap or be a starting point? But I don't know much more than that it exists.
Is there any evidence about people who's internal monologues ebb and flow? I have had a rich inner monologue at various times of my life, with droughts and many things in between. I find that I process many things verbally, often not realizing some emotion or preference exists until I voice-dictate it in to Daylio. I also love supportive therapy!
Re therapy and money, my favorite thing is how therapists justify the cost as "it has to cost a lot so you're invested in the outcomes". Which does make sense, to a degree: skin in the game. And yet, it's also what a psychoanalyst / TLP would call "a defense".
As far as "supportive therapy" goes, I totally agree. It makes me think of something Eric Berne wrote, about how there's 4 "levels" of therapy:
1. symptomatic control
2. symptomatic relief
3. transference cure (substitution of therapist for parent)
4. psychoanalytic cure (reveal the patient's fundamental conflicts)
My guess is that most supportive therapy takes place at the first two levels ("tell me about your anxiety" ... "are you feeling less anxious?") and MAYBE the third level. But it will never approach fundamental conflicts, although this isn't necessarily a bad thing, because, like with meditation, that's a door that you can't really close once you open it. Most people are happy to "return to society" after getting whatever support they need. Only in some cases does one need to go further.
My mom, a professional psychotherapist practicing "supportive therapy" (well, she'll call it "cognitive-behavioral with a psychodynamic bent"), has an anecdote from her years in therapy. She apparently reached a point where her therapist told you "this is as far as we can go together. If you want to dig deeper into your conflicts, I can refer you to an analyst." I don't think she took up her therapist on that offer, but to me it makes sense: there's different levels of interventions, that tackle different things and require different modalities.
Just chiming in regarding the internal monologue bit- I don't have one, and I am thankful for that. Having to think using words all the time sounds exhausting! I have no trouble using them as needed, such as posting this statement, or talking to someone. But I would say 90%+ of my thinking hours are spent considering concepts in a non-verbal manner. That doesn't mean that I don't have access to introspection. It just means that converting thoughts to words comes after the fact, not during.
I’m beginning to think that the word monologue used to describe this internal process of thinking through something is perhaps misleading, as it has a very direct connotation of spoken words.
Words are metaphors and I think it’s very difficult to engage in meta-thinking without metaphors being operative. It might even be impossible.
The metaphors might not be language but I find it difficult to imagine that any thinking human being does not have some sort of inner “monologue”By which I mean metaphors of some form. I would propose that language is the basic metaphor that is used to pursue a train of thought But with facility it can become second nature for want of a better term, and thus less visible.
Practicing at sport until it becomes muscle memory is an example.
How about “inner discourse?”
I think I don't want a therapist, really. I want an expert. I guess it's why I follow Scott here. I feel like I've got a solid grasp on my problems, and even a decent idea of what I ought to do to solve these problems. But I wouldn't mind talking with someone who is an expert in how the brain works and has experience in how to attack depression and anhedonia.
Would be cool if this expert could prescribe ketamine as well; I think that might help.
Boring take: people used to go to their local religious leader for the kind of service they now get from a therapist. But now they don't believe that person knows anything, or don't want to be alone with them, so they need to look elsewhere. But advice has always been what some people needed but not others.
Having a wise and confidential person in your life seems like a good thing, and giving advice involves triage. That makes it hard to make any general statements beyond "we expect people to know a lot of things" and "when you learn you don't know one after you were supposed to, asking for help can work" but also "getting bad advice is bad" and "authority doesn't guarantee correctness".
Now, from the therapist's perspective, it's helpful for triage if you know what's generally going on in someone's life without asking. If they're depressed this week but last week you spoke at their grandfather's funeral, that's what you might call a clue. And you'll share a cultural context in which to broach some difficult topics. If we've successfully split that role off, great! If you get a bad therapist it's easier to keep shopping than for a new priest or rabbi. But we shouldn't expect that specialist advice givers and generalist advice givers have a totally obvious and easy tradeoff.
Personally, I've tried therapists twice. The less bad one was merely useless and expensive. The worse one taught me genuinely harmful ideas that I spent my teenage years methodically forgetting. And then I got stomach surgery and it cured my depression immediately, so figure that shit out. I've given and gotten life-changing advice, so I'm convinced it exists. I've never gotten it from someone who promised that on their business card, but I have to imagine it's possible.
For what it's worth, the most consistently useful advice for people in my experience has been to not imagine your mind like a pilot flying a plane, where it's just you and everything is on you, but more like a captain on the bridge of a ship, in which you have a lot of voices and specialists and your job is to synthesize them all and make command decisions. Yeah, lots of people have a weird voice in their heads that they don't like. But if so, that isn't all of you and you can isolate each component voice. A good captain knows where their subordinates are coming from. Not a panacea but it's helped a number of people.
What sort of stomach surgery?
I don't know whether this is as big a problem for men, but if women go to a local religious authority, they're at risk for being told to stay with an abusive husband.
I am a SMART Recovery facilitator, and it has become incredibly obvious that sometimes people just need to think things out loud in order to get to the next thought. In fact, there's a famous computer program debugging technique called rubber-ducking because of the story some guy told of his boss keeping a rubber duck in his office and inviting his programmers to come in the office and discuss their programming problems with the duck. It works. I can't tell you how many times I've been stuck in a bug and just explaining it to someone *who doesn't even understand what I'm talking about* is enough to make the answer blindingly obvious. This really is a way of hacking the brain. Sure, in SMART Recovery we say we don't give advice because of the motivational interviewing principle of people will follow advice if they come up with it themselves; but I fully believe talking to someone or something else is just a simple hack of the way our brains work. I've watched too many people decide to get their lives in order and live a life they don't want to relapse from to come to any other conclusion.
Anecdotally: I don't have an inner monologue, and yet I definitely think my problems through. My experience of not having an inner monologue is that you're directly thinking through the concepts without bothering with "shrouding" them in language; trying to debate matters "verbally" (albeit in my head) seems to me to *obscure* the issue more often than not. As a result, my prediction would be on people like me finding therapy/conversation *less* effective than those for whom the discussion with the therapist will be a much rawer translation of what's ordinarily going through their heads.
Do I gather that when you're thinking problems through, it isn't visual symbolism either, it's something else?
You gather correctly! I realise it sounds somewhat woo-ish/pretentious to claim that I'm straight-up reasoning about abstract concepts, but I'm struggling to find another way to put it. (Well, I *can* also picture mental images fairly vividly if that's what the task calls for, of course.)
I have been very interested in thoughts related to how to reliably increase the agency of talented individuals, especially at scale. One of the many challenges here is definitely that everyone's' conscious experiences, world models, and self-models, are incredibly diverse, and it's very hard to learn a comprehensive representation of someone's internal structure in order to know what should be optimized (let alone how one would go about optimizing it, even if you instantly knew what should be changed).
I'd love to see any resources on how to increase the agency of individuals (bonus points if talented individuals + at scale) if anyone has any favorites to share
Would you say more what you mean by agency? What's the problem you're looking to solve, that you see increased agency being the solution to?
yeah, e.g. encouraging people to start/create more things, cold-contact more, and in general just significantly up the baseline for how much someone maximally modifies reality to achieve their goals rather than accepting it as a given
Much of this post reminds me of an XKCD comic: https://xkcd.com/1053/
I've been noodling on the idea that one pathway for therapy to be effective is to develop a secure attachment to at least one other person on the planet. This came about after reading the transcript for this podcast: https://www.janetlansbury.com/2021/03/the-truth-about-secure-attachment-with-bethany-saltman/ which is more about parenting, but it makes sense to me that everyone could do with having the experience of being fully themselves in front of another person and not being rejected but just quietly accepted instead.
> "Then they are delighted and go home! I sometimes think about this by analogy to “you can’t tickle yourself” - some people can’t reassure themselves either, and are very happy to hear thoughts they could have easily generated themselves coming from other people’s mouths. Are these some of the people who benefit from therapy? Seems plausible."
As someone who had/has an anxiety disorder that occasionally resulted in semi-obsessive episodes over some real-or-imagined danger, I can confirm that "people who can't reassure themselves" is indeed a real thing, and also that many of these episodes were resolved precisely by having a doctor (or other relevant knowledgeable person) tell me something along the lines of "this isn't even plausibly worth worrying about, go away."
This isn't so much about the reassurance factor of a trustworthy labcoat-wearing authority figure (although that may help), more it's about simply having an external reference point to calibrate against. An ordinary person sees a garden snake, isn't scared, and goes about their business; someone with anxiety sees a garden snake, feels scared, and suddenly has to decide whether this is just their anxiety disorder acting up or if it's their pre-reflective common sense telling them they're in real danger of being bitten by a poisonous snake that looks like a garden snake. This is a surprisingly difficult thing to solve through introspection and self-talk, since these processes rely on precisely the kind of fuzzy intuitive faculties which are malfunctioning in this case. But if someone just tells you that, no, their fuzzy intuitive faculties say everything's fine, you have some solid evidence to decide in favor of the "I'm just having an anxiety attack" hypothesis, and can move on.
(At least, you can move on to the stage of simply gritting your teeth and trying to tune out the parts of your brain that keep yelling that you're in mortal peril, but progress is progress.)
That's all an example in the case of anxiety, but I'd imagine "therapist as a reference point for internal calibration" is a broader phenomenon. Humans have *lots* of fuzzy intuitive faculties, and many of them concern judgements of very private things you don't usually talk about to someone aside from close family and friends (who are liable to have similar problems to yours!) and therapists. It's probably very easy to go through life with badly-calibrated intuitions for how people feel about you, or for your general prospects in life, or for how to navigate intimate relationships -- even in cases where a simple explicit check-in would correct the problem. Therapy is, among other things, how our culture administers these check-ins.
> "This is a surprisingly difficult thing to solve through introspection and self-talk, since these processes rely on precisely the kind of fuzzy intuitive faculties which are malfunctioning in this case. But if someone just tells you that, no, their fuzzy intuitive faculties say everything's fine, you have some solid evidence to decide in favor of the "I'm just having an anxiety attack" hypothesis, and can move on."
Very well-put!
yeah, when you're in the throes of an episode, that little internal reasonable voice about "now I know it *feels* like you are dying but you are *not* dying" is no help at all. External source is much better. Like the doctor who, when I was bleeding like a stuck pig (women troubles) was very matter-of-fact and prosaic about "oh yeah, this happens" and gave me a prescription for medication and told me it should stop soon but at the very most it should stop in two days. Immensely reassuring and brought me down from the panic faster than anything else.
I think a lot depends on the context too. I'm generally psychologically healthy, but I benefited tremendously from a grief counseling session after the death of a parent.
We as a society have always needed calm, wise, objective people to help us talk things through. Back in the days when most people were religious, priests, ministers, & various clergy members often performed this calm listening function. In Asian/African cultures, it was often village or community elders. Therapists have taken their place. But the need has always been there, and societies have found ways to meet it.
I'll lend my support to this: when I slipped into a deep depression over the death of my aunt, I needed a therapist to help pull me out of it. After getting out of "the hole", I was able to take in better ideas that have so far kept me out of it, and I don't need a therapist at this point. If I end up on a hole again... well, I could turn to a therapist, or to a monk I know- both seem to function on roughly the same level in terms of getting-people-out-of-holes.
I was surprised when I heard that some people don't have an internal monologue; it made me wonder how their decision-making actually works. Apparently there are also people who have no mental visual imagery either. Now I wonder what people with these deficits think about the rest of us; do they suspect we are hallucinating? Hearing "voices" and seeing "visions" would only be a more extreme form of these mental processes.
I am not sure, cause I kind of have the opposite impression, at least for internal monologues: it feels like a semi-failure of decision-making. It's not that I lack internal monologue, but most of the time it is not present, or at least I do not consciously realize I am speaking to myself. When it happen, it's because the decision is hard to reach and there is a lot of back and forth change of mind, pro and cons being re-evaluated...
This is imho the mark of a very inefficient process, exactly like reading by "speaking in your head" is slow/tiring. Not as slow as reading aloud, but much worse than not even thinking about the sound.
But when you explain to people learning to read (sometimes reading aloud) that to get better, they should stop mentally pronouncing the sound, that it's the next level in term of speed and effortlessness, they look at you like you are crazy: Thzey think "how would I read if I do not pronounce the word, at least mentally? It would not be reading the words, just having a quick look at a bunch of letters?". And they will be right, I think at first you lack direct connection between visual pattern recognition and meaning units, and reading without (internally) making the sound is just not possible.
Internal monologue is maybe the same kind of crutch to decision making as mentally reading aloud is to reading: the proof that you are inefficient and struggling in unknown territory, instead of doing something really well (a direct connection between set of informations and goals, and an optimal chain of actions, probably because you had done something very similar int he past) . In fact, if I look at the time I remember the most vivid internal monologue when deciding, it's exactly that, and a sign that my decision was likely quite shaky...
Well, yes obviously. I really only use internal dialogue for difficult decisions or for when I am preparing to do public speaking. And I have not "pronounced" words whilst reading since I was very young, unless it's poetry.
And do you think internal monologue helped, compared to non-verbal decision making (aka do what feels right, do not overthink it)? Honestly, I do not think it does. And If the self/inner voice is mainly an a posteriori, rationalization (in the form of a single-threaded story) to a multi-agent parallel brain (probably mostly usefull to organize memory) ( A view quite popular if not dominant in the neurosciences), internal monologue is in fact a failure/inefficiency of this process, not really a way to improve the end decision...But It may improve the story about the decision though, to be told to yourself or others. Which is also important, but in antoher way (make the decision more socially acceptable I guess - which would predict that inner monologues should be associated not to difficult choices, but difficult justifications )
There seems to be an idea here that the internal monologue is a weird outlier, but it is far more common than not, to the extent that most people were surprised that some people didn't have it. What do you think those voice overs in movies are all about? Stream of consciousness is a term dating back to the 19C, and Daniel Oliver, the guy who invented the phrase didn't claim that it was rare - he was describing something that we all were assumed to have.
So it's odd to find out that this isn't universal in 2019 or so, and also to be on the internet and find that a lot of people , seem to not have it . Maybe that is because of the nature of the internet, or this blog? Its odd that we just found this out.
Anyway, my own inner voice isn't really a hinderance to other thoughts, I can be thinking word thoughts and solving puzzles at the same time. Ideas come and go.
> And I have not "pronounced" words whilst reading
So when you read this sentence, what happens in your head?
Speaking as someone who doesn't mentally sound out words while reading, I'd say I just... become aware of the meaning? I don't know if there's a clearer way to express it than that. When multilingual people hear someone speak in one language they understand, do they have to mentally recite the words in another language before they process it as meaning? Speak very little of any language other than English, but I don't think it usually works like that, they just understand the words in the language they hear them in.
I think it's essentially like that. The written words are already an expressed form of meaning themselves, I don't have to convert them into a different, audible form to understand them, I just understand them in their visible form.
I don’t know if the multi lingual thing works as an analogy. Both are languages.
When someone speaks do you hear the words? To me that’s no different than writing, in fact if a friend writes to me I hear his or her voice in my head. For a novel I can hear the accent of a person speaking if I know it, and the voice is also gendered. Narration is neutral or in the accent of the protagonist if it’s a first person narrative.
If someone is telling me a story I see the images, as well as the words, which fade into the background. Same with a well written novel. I can’t do that with non descriptive prose though, I read your argument in my head in a neutral accent. I don’t picture your argument, but if you started on a story to illustrate your point I would start to see images.
(The neutral accent isn’t American or my own Irish accent. Hard to explain but very bland).
Written text is also a language; I don't need to translate it into a different form to extract meaning from it.
For me, the notion of needing to hear words in my head to understand writing is just strange. The sounds aren't the meaning, the sounds are a symbol intended to elicit meaning, as are written words. The meaning exists in my head independently of either. I *can* imagine actual speech in my head, and I do so when I write dialogue, but it's much more effortful than just parsing the meaning. When I read your message, I don't ascribe any sort of vocal character or accent to it; it's as much a category error as trying to express what your message smells like.
As someone who actually has little to no mental imagery, I absolutely do not think that people who do are hallucinating. Because I was socialized with people who did have the ability to form mental imagery, the way you describe your thoughts became the way I describe my thoughts. If you ask me to picture an apple, I will say "okay I am picturing an apple."
What I'm actually doing is collecting a list of concepts that apply to an apple: apples tend to be red or green, they're mostly round but they have little dimples on the bottom and a stem at the top. Until late in life I thought that's what picturing an apple *was.* I was often impressed by how many details about an object a person could hold in their head at once, but I never thought they were hallucinating. I just thought they had a better ability to perform the above process than me.
The only time I've been baffled or confused by the concept of "imagining" as a visual process was when I was trying to improve my memory, and books kept asking me to form a "memory palace" where I could "put" the different objects I was trying to remember. That's much more work for me, so it seemed like an insane person saying insane things.
But tl;dr: The words people use to describe their thoughts are just words. And since they're in common usage, and since I've never seen the inside of another person's thought process, I just automatically analogize to how I think.
Supportive therapy was most useful for me when I was a confused ball of emotions about some ongoing or recent trauma.
A kind, steady, professional listener was helpful in those cases to help me figure out… where I was overthinking and where I was under thinking.
As I get older that seems less useful because both me and my friends have grown wiser and emotionally more capable, so we figure out 90% of that between ourselves easily. That seems like a common pattern.
I’ve never found supportive therapists to be useful in developing myself, though plenty of other things have been, including fairly mundane things like corporate management training.
Question for author - what are the areas of “basic human functioning” in which you suspect you may be deficient? I guess the term “deficient” also needs a definition, but it’s the same framing in your final paragraph, and I’d be curious to hear your answer... It struck me as a sentiment that is admirable for its vulnerability, probably universally true, and potentially interesting area to explore further. What thought patterns, aspects of self-awareness, intellectual qualities, interpersonal behaviors, etc. qualify as essential to “basic human functioning”?
Maybe this is merely tangential, but most of the value I perceived in seeking a professional for improving mental health is through the use of tools, exercises for psycho-social intervention. Therapy is one way to acquire them, another is just picking up a workbook for popular forms like CBT or 3rd wave CBT. My impression is that therapy is not usually about this, unless you explicitly seek it out. Maybe that's a problem, since in popular discourse everything is conflated.
When it comes to questions like "my job sucks, what do I do now?", you confide in people you know or look online. If the problem is depression or ennui, I think talking is insufficient.
Some things are easier to see from a distance and to be seen clearly by someone for whom doing so isn't emotionally expensive. I know I lived with faulty assumptions about myself that would have been difficult to have intuited or reflected my way out of. Maybe what I got wasn't "supportive therapy" but it was incredibly helpful.
As someone who was handed a bundle of really unhelpful ideas as a kid (see: Evangelical Christianity), and whose university experience only reinforced and expanded those bad ideas, therapy was extremely helpful to me.
I was depressed, isolated, full of self-loathing and inner conflict, and literally had no one to turn to who could actually help me, because I had spent the last many months pushing them all away. My quality of life was complete shit, and it was well worth $100 a week to improve it.
I’m not saying therapy is always worth it for all people. Some therapists are terrible. Some people are relatively psychologically healthy. But that’s certainly not a given. For many, therapy is a lifeline.
You went to an evangelical university?
Fundamentalist, actually. They split with the Evangelicals over their lack of scruples. I graduated from Bob Jones University.
Joshua, I'm happy to hear that you improved your situation. Good wishes to you, I hope you continue to make things better. My experience is similar, I received a lot of bad programming as a child; I stumbled upon cognitive therapy in my late 20's and it helped me a lot.
Also, I hope you don't mind me saying I'm fascinated by your story: raised Evangelical, graduated from Bob Jones University, and now commenting here. I think this says a lot about the diversity and acceptance of this community.
Thanks, Banjo. Indeed it does say a lot about the diversity and acceptance of this community. It also speaks to the power of ideas to transform a person’s life. I left faith about 10 years ago, and I have been dramatically happier.
I can't imagine ever paying for therapy now--I'm somewhat too private. I feel a need to write journal entries thinking things through when I'm upset or having difficulties, but I'd rather think everything through on my own. There's lots of things I wouldn't share with my spouse, let alone anyone else. I guess I also doubt that another person would be able to do anything for me that I can't do for myself.
However, my 2nd-grade teacher referred me to the guidance counselor because I seemed sad a lot or something, and that lady has a very warm place in my heart. I told her all about my mildly abusive family life, and she told me that it was wrong for my parents to treat me that way, that there was nothing wrong with *me* that was causing this but that unfortunately some parents just don't treat their children the way they should, and that I should remember not to treat *my* kids this way when I grow up. Then she sent me on my way after a few meetings.
I think those were exactly the right things that I needed to hear; they really stuck with me. I'm not sure, for lack of a control, but it's possible that those meetings helped to inoculate me against some of the normal negative psychological consequences of a mildly abusive childhood: I never had any self-esteem problems, and was never tempted to think that any of it was my fault. She also shared things about how *her* family worked, which helped give me a healthier picture of what "normal" looks like which was different from what I was seeing at home.
With adults, alas, it's too late to inoculate, but some of that sort of thing could help an adult too.
So, the linked article about internal monologue is actually discussing inner speech. This might seem like a meaningless distinction, but if you asked me if I have an internal monologue, I would say yes, but if you asked me if I have inner speech, I would say no, or at least, no given my best understanding of what that's intended to mean.
As people go, I'd say I'm a pretty highly introspective person. I spend a lot of time thinking about the information I have to construct my understanding of the world, my own feelings and motivations, the feelings and motivations of people around me, etc. I think from my experiences I can say that I'm better than most people at predicting how I will feel or act in various circumstances, and how various life changes will affect my mental state.
But, I don't conduct this internal monologue in words. I *can* process thoughts in words; I write fiction, and when I write dialogue, I play it out in my head to check how natural it feels. But the idea of conducting all my introspection in words honestly feels really weird, slow and inefficient. Words are for communicating with other people. The idea that I'd need them to express thoughts within my own head feels bizarre, like if moving a file from one location in a computer to another required turning it into a huge verbal description in an MS Word file so the computer could understand it properly.
I don't think people without internal speech are necessarily more introspective than people with it, but I think it's worth being clear that a lack of internal speech doesn't necessarily inhibit introspection either. Some people may almost entirely lack introspection, but this would be a different, and probably harder to examine, matter than lack of internal speech. If someone is sufficiently non-introspective, are they capable of being aware of their own lack of introspection? I've definitely known people who give me the impression that they're not.
> But, I don't conduct this internal monologue in words. I *can* process thoughts in words; I write fiction, and when I write dialogue, I play it out in my head to check how natural it feels. But the idea of conducting all my introspection in words honestly feels really weird, slow and inefficient
I am curious about this. Could you describe the form your thoughts take without words.
I understand information that I might describe as somatic in nature; feelings and sensations that inform me, But I wouldn’t call them thoughts.
I'm not sure I can properly describe it except subtractively. If someone told you that they can't process written words without seeing someone speaking them, you could tell them that you experience the same comprehension minus the visual component. For me, I experience the comprehension minus the auditory component.
Hearing other people say that they can't process text without an auditory component, or can't internally process meaning without words, puts me in mind of one of Scott's works of fiction-
https://slatestarcodex.com/2015/04/21/universal-love-said-the-cactus-person/
...since to me, not being able to separate meaning from words or auditory representation feels like lacking a concept of "getting out of the car." The words are not a necessary vehicle, you can get from one place to another without them, and some terrain is more easily covered without them.
In this construction are concepts labeled?
I am thinking of a process of manipulating triangles in my mind, but it’s already DOA because “triangles“.
The need for an auditory support:
I agree with you on that. I don’t have to hear the word although clearly I like to because I usually talk out loud when I’m having these discussions.
I think of the dialogue in a play. It’s one thing to read hamlet and not speak it. But hearing it spoken well is quite a step up from just reading it. There is a quality of concreteness that comes from speaking a word, or hearing it’s spoken.
I think that depends on what you mean by "labeled." They can be more or less fleshed out. There have been a lot of cases where other writers have fleshed out ideas I've already previously held in some less developed form without having names for them. After reading their works where they put names to the concepts, I'll use those names whenever I communicate the ideas with other people, but I don't need to express those labels verbally inside my own head. But, I'm aware of the additional depth they contributed to the concept when I think about it, without having to actually think in terms of the name.
I still remember the first time I realized that other people I knew in grade school actually, you know, did stuff after school, and in a sense "had lives".
I'd say my inner monologue is the source of 80% of my problems. Therapy is often useful to me specifically because it's NOT that.
I once went to therapy because I was feeling paranoid about an issue. After a few sessions, the therapist assessed that these worries were normal to have and my reaction was proportionate. In other words I wasn't overreacting, I was having a big reaction to a big problem.
Once I heard that, I did not stop worrying a lot until that issue went away, but I did stop feeling overwhelmed by it. The therapist's opinion allowed me to accept that I was feeling big feelings and removed a huge part of why these feelings were problematic in the first place.
I'm confused by the basic assertions - isn't Scott Alexander a professional therapist?
or am I confused and he is a psychiatrist?
He is a psychiatrist, MD, and somewhat ambivalent about the merits of talk therapy. He prescribes drugs.
Drugs work great for helping some people with their issues- they worked awful for me. Now, this might simply be because I was on the WRONG drugs (this is the psychopharmacologist's usual retort) and being on the RIGHT drugs would have stopped my depression from spiralling and pulled me out of the hole. But they didn't, and the psychiatrist outright refused to recommend my family a therapist until things had gotten much, much worse because he earnestly believed (based on the general thrust of our discussions) that every bad thought or feeling could be medicated away and that the entire field of psychology (separate here from neuroscience and psychopharmacology) was pseudoscience. Now, I don't think Scott believes this- but I think it's a pretty common attitude in psychiatry to think your preferred treatment method is manifesting the destined form of Mental Health Treatment and every other, lesser approach is now an outmode. Talk therapists can fall into this too.
A propos: I wrote in another comment that there is such a thing as non-pharmaceutical intervention strategies that research suggests is generally effective. That could belong to "therapy", but in the common lexicon therapy refers to "talk therapy". I think this confusion does a disservice to people because more would benefit from applying CBT or 3rd-wave CBT exercises.
I totally get what Qiaochu is saying - it's the kind of insight that sounds either like a platitude or tautological once expressed in words.
I noticed people struggling in life don't have that attitude - that problems are solvable, that whatever causes you pain in life is subject to the same approach as a dripping sink or a flat tire in your bike. It seems like you can actually lose this insight by cultural osmosis, if you spend a lot of time with people who have this kind of learned helplessness, you start to reify your problems as something that just happens.
I think the lesswrong alief vs. belief distinction is very relevant here, you can believe "problems are solvable" just fine but it does nothing for you, while acquiring the alief is life changing.
Completely irrelevant to this post, but the "it's impossible to do anything" attitude of my peers is about to drive me absolutely wild, and I'm glad I'm not the only one to notice.
I'm sympathetic to Scott's speculations here about why different people would be helped more or less by therapy. I would add an evolutionary psychology dimension to the story (yes, it's a bit of a just-so story, but that's fine for a hypothesis).
Humans evolved to live in small clan groups, mostly under Dunbar's number. Under such circumstances, one is constantly receiving social feedback from people with whom one has some degree of intimacy, to include authority figures such as clan elders. We may have evolved to rely on such feedback for our problem-solving and basic sense of stability and wellness.
Under modern conditions, we often lack such social feedback, in both quantity and especially quality. Therapy often serves to fill that niche. Some people refer to therapists as "rental friends," but they actually may be more like "rental aunts & uncles."
Oh, I have no problem at all with an inner monologue, or even an inner dialogue. My problem is that I can talk myself right back into where I started from and nothing changes. Having someone exterior that doesn't follow the little script I write for them in the internal dialogue would be so much more helpful.
Absolutely. I share this experience. I’m much more likely to have a reasonable conversation with myself these days but I’ve had quite a bit of therapy and on the whole I would say that’s been a very positive thing.
A quick mind is not always an asset
Conversation wise I mean: internally.
I think it’s more difficult to get a quick mind to listen, thus the monologue.
I would agree with you and many of the others in therapy discourse that therapy-as-a-means-of-just-talking-to-someone represents a large percentage, if not he majority, of therapy patients. Smaller, more atomized families coupled with technology limiting the availability of intimate in-person settings to have these deeper conversations mean that people have to spend more time inside their head. This allows their own cognitive deficiencies and biases to play an outsized role in their psyche, rather than having someone to sense-check or empathize with their feelings.
I think therapy can be very helpful in sorting out the various versions of oneself.
I think Freud‘s Oedipus complex is a very good summation of the whole whore – Madonna dichotomy which as we all know is a strong cultural trope and has been for a long time.
"Other people obsessively seek external reassurance. I talked here about the phenomenon of hypochondriacs who go to their doctor to be told that their latest concern (maybe the 25th time they had a certain symptom) isn’t worth worrying about, same as the last 24 times. They’re not even asking for an x-ray or something! They’re just happy to hear the doctor say the words “given that your last 24 symptoms were nothing, I’m assuming this one isn’t anything either”. Then they are delighted and go home! I sometimes think about this by analogy to “you can’t tickle yourself”"
huh... i suppose that describes me pretty accuretally. i have that sort of need for external reassurance for a lot of different things, with the added effect that i tend to loss the order i mentally need to continue doing it because i get uncertain, so just having someone to validate it can make me not panic when trying to do it... interesting
I was really hoping for someone to address the "benefit" part. What is the expected/supposed benefit? Obviously some people like to discuss their problems with someone paid to be non-judgemental. Is it done just for this contemporaneous enjoyment? Is there a temporary benefit that wears off over time and it is expected to continue this type of therapy for ever? Is the benefit is to address your problems make some realizations/improvements fix your issues and be healed, then the therapist just lost a customer. My assumption has always been it's the later, but based on the habits of people I know that go to therapy that doesn't seem to be the case. Or as a group they have terrible or fraudulent therapists?
I can say when supportive therapy has helped me and when it hasn't.
The time I benefited from supportive therapy was when I was diagnosed with a major psychiatric disorder (Bipolar 1) and finally accepted it. (I had been diagnosed once before and /not/ accepted it and this only went very well until it suddenly went really, really not very well.)
Having an older therapist who could credibly claim to have seen it all listen to my fears, whether I could do all the things I wanted to, whether it was 'real' or I'd just somehow tricked everyone including myself into, and so forth, as well as being able to make me realize I wasn't the only person this had happened to and recommend a few autobiographies helped me calm down enough to start approach things as a skill to be learned and mastered.
Especially for matters with a stigma about them (or if your family are people whose response to finding out you have a mental illness is to tell you it's a punishment from God), it's easier to be open with someone who has a lot of experience talking to people with similar problems. This therapist said I was done with therapy about the same time I felt like I didn't have anything more to get out of it.
Where it didn't help at all was treating an eating disorder. After realizing I had one thanks to a nutrition blog one of whose authors had /also/ had one and gave the advice that trying to make major changes to your nutrition /without/ addressing an underlying disorder will likely fail, I got referred to a therapist. Who was a supportive therapist and spent three years accomplishing nothing.
Leaving that therapist and going to a CBT/DBT therapist who took a very structured approach, assigned reading material, gave specific behavioral changes to work toward as Thing One, and gave homework like structured journaling was very useful. She didn't talk about my thoughts and feelings except through the lens of stressors, triggers, maladaptive patterns of thought, etc. Exactly how good she was at her job was impressive, I could feel myself going from "I can't imagine giving this up." to "Wow. I don't even like this." over the course of months and she had specific clinically set goals and when I met them, we were done.
It seems like your approach is the one I would assume, the therapist is helping your or teaching you how to address some issue and as such the therapy should be temporary - until the problem is addressed. Theoretically, better the therapist the less time you'd need to spend in therapy. The never ending supportive therapy is seen as a failure.
It seems like a lot of the the "therapy is great" folks do not have the same expectation in mind. The original question "therapy, good or bad" would depend on whether your expectations aligned with what therapist thought there job was?
I have a hard time understanding why someone would pay thousands of dollars over many years to waste time venting to someone. I suppose it's like the difference between going to a physical therapist to fix a bio-mechanical issue or going to get massages on the regular because it feels nice.
People go to therapy for so many different things -- from couple's counseling to ADHD coaching and everything in between. The therapist helps the patient/client articulate one or more goals from whatever the presenting suffering is. Sometimes the suffering is depression and the benefit is alleviated depression. Sometimes the suffering is a bad relationship and the benefit may be better communication skills to improve the relationship or it may be clarity to get out of the relationship.
In general, the benefit is ameliorating some form of mental (and sometimes physical) suffering.
My question is whether that ameliorating is supposed to be temporary or leading to a permanent correction that would alleviate the need for future therapy? From what I've seen once people start seeing a therapist they tend to go indefinitely, which obviously doesn't fit with concept that the therapist is actually providing a good pathway to a permanent fix. I'm wondering what I'm missing here....
The aim is sustained change, but also change can be a life-long process, so it's very individual whether a person wants to continue to work on things in therapy, work on them intermittently, work on new things, or not.
Lots of people go to therapy for a time to address a specific issue and stop when they've addressed the specific issue to their satisfaction. Lots of people go to therapy for a time and then return to therapy another time for another issue or a deeper round of work on the previous issue (that doesn't mean that previously there wasn't change or growth or resolution, only that now more change may be desired). And some people do see therapy as a space for ongoing growth -- whether one sees that like practicing at a dojo or visiting with a priest.
If a person comes to therapy to treat depression and the only way that therapy helps them is during the very hour that the person is talking about their depression and they are taking nothing beyond the hour to practice in their lives, then I would say that's not successful therapy. Therapy is not designed to be a crutch. It's a learning space. People use that learning space in different ways.
I don't understand the title.
I think it's parodying a meme in which people say men will literally do X rather than go to therapy.
I was wondering the same thing. Thanks
I'm not sure if you're being facetious, but I really think there are many people who have "no ability to systematically think about and solve" problems. I know several personally. Perhaps, then. we are too harsh when we criticize people for making bad choices in life. Maybe, as you suggest, they actually lack the ability to make proper choices at all?
The idea that "everyone is defective in some sort of basic human functioning" also struck me. I wonder if this is a trend over time? For instance, were our grandparents and great-grandparents much less lacking as a whole? Is the increase in people in therapy over time because of greater self awareness, improvements in the field and less stigma attached to seeking help -- or because people today are more "defective" than before? And if the latter, could this be reversed and/or trend the other way at some point?
Absolutely I agree, no point in criticizing people for making bad choices. People make the best choices they're capable of with the ingredients they have at any given time. Adults do have some responsibility for learning what better choices might be out there for them to make, but that also asks people to learn things that society as a whole doesn't necessarily provide much support or modeling for (speaking for this particular society I live in where instant gratification, empty striving, and emotional displacement are avidly promoted). We can't lay all the responsibility at the feet of individuals, even adult ones.
We could do a survey of people's grandparents in terms of functioning. My grandparents on one side: alcoholic, OCD, depression, sexual abuse, successful farmers, very smart children who became professionals. My grandparents on the other side: very ambitious, high-functioning, professional, also alcoholic, depressive, anxious, and sexual abuse. Also domestic violence, both sides. No "serious" mental illness (ie, bipolar or schizophrenia, no suicides), everyone had jobs and raised kids and appeared to be functioning to the outside world. Totally f*cked up otherwise, leaving trail of intergenerational crud. Also many good things.
It seems to me people are headed towards somewhat more emotional intelligence and willingness to talk about difficult things rather than just drinking or raging to avoid them across the generations I've witnessed, but I could be totally wrong.
In my experience everyone has always been broken forever, the old much worse than the young (with the exception of a small band of folks who had the misfortune to come of age at exactly the same time as Facebook, see Jonathan Haidt).
But I do think expectations are higher. Young people expect (or at least hope) to achieve some level of happiness, personal freedom, romantic success with a partner they truly care for, career success with some level of progression, fulfilling hobbies, a good social life, a white picket fence, kids, a dog, for people likely to go to therapy a college-level education, financial stability, the list goes on and on.
Meanwhile our Depression-era grandparents and great-grandparents considered hotdogs to go into the beans a special treat. The further back you go the lower the expectations.
In many ways the younger generations get the worst of both worlds, as they actually do have a lower standard of living than their parents (arguably at least). So not only do they assume they can and should have it all, the influential adults in their lives do too - and are disappointed when they don't.
People are, indeed, broken - self-awareness is a curse for the self-aware animal.
I think traditions and religion were load-bearing in a way that's not obvious at a casual glance, and we threw out the baby with the bathwater when we went full speed into modernity. A new, resilient psychological/social frame will establish itself at some point, but it might take centuries. In the meantime we all suffer.
I wish there were more alternatives to therapy, because it does seem like a gamble that I would be able to correctly identify the source of my problems, and then communicate it, to someone who will then give me useful suggestions I can implement.
I wish instead of therapy, I could pay to just be in the company of folks who know how to relate to others in ways I didn't have modeled for me. People who were raised in difficult environments can probably relearn a lot just from observing other people, but if they picked up difficult behaviors or self-loathing attitudes, it can be hard to get invited to parties.
It seems to me there are some alternatives anyway. Self-help groups, meditation classes, yoga, massage, acupuncture, church, knitting circles, bird watching groups, hiking adventures, workbooks, art classes, mental health apps, philosophy books, journaling, relationship workshops, psychedelics, antidepressants, breathing exercises, herbs, world travel, training for a marathon, falling in love, gardening, changing careers or locations. I mean, it depends what concern one is looking to address, but lots and lots of people solve the kinds of concerns people bring to therapy in all kinds of other ways.
When people come to therapy, they almost never have correctly identified the source of their problems. The only thing a person needs to come to therapy with is some provisional description of how they are suffering and a desire to alleviate the suffering. The rest of it is figured out in real time.
Interesting speculation, Scott. I think there's something to it.
No one has ever suggested it, but perhaps I should go to therapy to find out if I need therapy?
There’s definitely been a recent emergence of a sort of “mental health industrial complex” that has become bloated and as a result needs as many people as possible going to therapy to justify its own existence. I say this because social work and mental health counseling have over time become some of the most popular and least rigorous programs at universities in the US. As a result these programs are churning out licensed therapists who partied their way through undergrad + masters programs (the few I know personally literally faked their thesis and graduated with honors) and thus are unequipped with the either wisdom or expertise necessary to help people navigate the nuances of their psyche. I went through multiple young therapists offered through my insurance and was sorely disappointed that they really brought nothing to the table outside of repeating cliches that could be found on a “mental health” tik tok page run by a 16 year old. I was a “functioning” addict and even had one therapist suggest I should keep using my drug of choice if it helped with my “anxiety.”
Unfortunately, it wasn’t until I left the insurance system and paid top dollar for a therapist with 20+ years of experience that I was finally able to see the benefits. She had seen it all and knew a ton about the nuances of addiction, ADHD, and the ways it manifests in different people. She was brutally honest with me at all times and I credit her with helping me get sober.
So yeah, I think the point here is that being a good therapist is difficult and takes a lot of experience and knowledge. Humans are complicated. Unfortunately there’s at least as many bad therapists as there are good ones, if my experience is any indication.
It's true, the training in the U.S. now is mostly terrible in the standard grad programs and most therapists' actual training happens once they start practicing, hopefully to start with under the supervision of someone senior and solid. I think grad programs are completely confused about what they're teaching and the standardized accreditation has required programs to focus on checking off a long list of superficial "competencies" rather than training in deep skills.
For all of the buzz “mental health” gets in the popular press and the way people say it should be treated as seriously as “physical health” (something I generally agree with), you think we’d also be in demanding greater rigor and oversight of mental health professionals.
I didn’t want to get into this in my original comment, but a good portion of therapists coming out right now are MSW’s. A good portion of their curriculum is learning to look at the world through the lens of leftist identity politics. For many their approach to therapy starts and ends there. If you’re black and see one of these therapists, your depression is obviously because the world is racist and you have racial trauma. For me (white guy) it was because of “toxic masculinity”. Looking at the world this way is pretty much guaranteed to make your mental health worse, it’s like the anti CBT.
I avoid therapy like the plague for this reason. I expect my therapist to either believe in an ideology I don't share, or just be unable to empathize with my viewpoint - they work using soft skills with people, their social bubble is doing the same, and they're either a woman or a way older man.
Meanwhile I'm a relatively young STEM nerd and I feel they have no points of reference to problems I'm facing, or the approaches I use.
Well I mean, in theory just because someone differs from you in their ideology doesn’t mean they couldn’t help you or empathize with your viewpoint. But I definitely understand your point here. I don’t think you should write off therapy all together because there are in fact real professionals doing great work, they’re just the minority.
If you look at my original comment, my journey ended with a therapist who had decades of experience. The training for therapists 30 years ago (while having its own flaws) wasn’t nearly as ideological in nature. Idk what her politics are but she’s definitely not “woke” and was really well versed on both the neuroscience and subjective aspects of human psyche. Perhaps you would benefit from someone like her, or perhaps not. I do think the people who could benefit from a *good* therapist is greater than the amount of people who go to therapy.
It seems hard to believe that no one has correlated the results of the various personality tests with clinical outcomes vs therapeutic approach...
Oh that would be fun!
In terms of MB typology, all the IN types are common clients as well as therapists. Also, I know my practice is skewed this way, but high in conscientiousness, in terms of the Big Five. I assume openness to experience and agreeableness are to a certain extent necessary to get people in the door. I gather young men tend to skew E, low openness, low conscientiousness, and low agreeableness. For sure people who are high in neuroticism (the other of the big five traits) would make likely therapy clients.
But I have some clients who are the opposite of all these things who have had very successful outcomes in therapy, so it must be a different question who is most likely to go to therapy and who is mostly likely to have good outcomes.
Wouldn't it be a great study? Use your personality profile to choose your treatment approach!
My graduate school advisor did this. The computer system gave each client in the clinic a battery of tests, and each therapist in the clinic also was personality tested. The clients were then matched with a therapist who was most likely to be compatible with them on personality dimensions and based on what modalitites they were proficient in.
It's called Systematic Treatment Selection, Larry Beutler.
It's so clear on paper, of course it's not routinely done...
I thought it was a cool idea at the time. Now I do almost all forensic work, so I am not really in the treatment world.
What does the title have to do with the body of this post?
I think it's parodying a meme in which people say men will literally do X rather than go to therapy.
I've heard the meme and I understand that the title is a reference to that meme. But beyond them both referring to therapy I don't see how the title is related to the body of the post. T body of the post is also about how different people have different mental processes so therapy isn't helpful for a large portion of people given their mental processes. Ok I guess I see the relation.
I've talked intermittently with therapists (broadly defined) over the last 20 years. It was only rarely helpful, but the few times it was helpful it was life-changing. I'd put the usefulness of therapy in three categories:
1) The large majority is rubber-duck debugging. It's amazing how many problems can be solved by just explaining them--somehow, for very many people, just explaining them with no worry about "what will this person think of me?" is enough to shake the solution into useful focus.
2) The more-helpful minority is asking good questions. "I'm having a problem with X." OK, tell me about it. OK, how about Z--is that going well or is there also a problem there? Have you considered Y? Sometimes, answering the right question clears things up a lot--but realizing that's the right question to ask and answer isn't easy to do for yourself.
3) The life-changing one for me was a missing tool. I was a 23-year-old freshman in college, trying to adapt to a different culture and with a history that posed some mental challenges. I talked to the school nurse, and she gave me this advice: "When something is going on and you feel stressed, try to decide if you are stressed about this thing on its own, or if it reminds you of something else and your stress is driven by the thing it reminds you of." That's been an amazingly helpful framing.
I don’t think “therapy helped me realize x” means what it sounds like it means, especially in the context of very obvious things like “I can solve problems with my brain”. It’s not “I would have disagreed that x is true before therapy” or “I’d never heard x before”, but more “I intellectually knew x was true but hadn’t ever really thought about it or internalized it to the point of usefulness”.
An example could be x = “I don’t have to keep relationships that make me unhappy.”
If you’d asked me directly, do you have to keep relationships that make you unhappy? I’d have said no, but when evaluating a given relationship in my life, I might not have been even asking the question “does this make me happy?”, instead evaluating it on things like “what do I owe them?” and “how painful would it be to try to end this?” and would have ended up keeping friendships or family ties that made me miserable. Therapy might help me think about that question more explicitly and help me consciously agree that it’s important and something I should value highly - it’s an explicit value realignment that you can clearly remember doing and reference in the future.
(For more example taken at a cultural rather than individual level, a thing the west coast has internalized that the east coast has not is “my happiness is important”, while the west coast could use a healthy dose of “some things are more important than convenience”)
I 100% agree with this take - it's very easy to know something but not apply that knowledge because you're using the wrong filters. You may be rationalizing, may be in denial, or you may just not identify a problem as the kind of problem to which obvious solution X applies.
This is one place where the rationalism project really falls down for me tbh: It's very good at figuring out how to make already existing frames of thought better ("Oh, I thought it was unlikely that a pandemic would occur but actually recent news makes me think it's more likely.") But that kind of thinking, at least for me, leads to focus narrowing. And all the smart things I've done in my life, whether making major life decisions or solving small problems have been done not by carefully weighing all evidence in a frame I'd already created, but by applying obvious, common sense solutions to a problem they did not obviously apply to.
Talk therapists have the invaluable tool of perceived authority. Like a hypnotist, this gives them the power to mold the thought process of their suggestable patients.
For example, IMHO, there seems to be two major (and opposite) tactics to make neurotic people feel better about themselves. Either, tell them: (A) "You don't need to feel bad, because you are a person with agency who has the power to control your feelings and actions. So be optimistic and empowered and change the things you need to change." Or tell them: (B) "You don't need to feel bad, because you are a person who has no agency due to a psychological condition that prevents you from controlling your feelings and actions. So just resign yourself to accept who you are and don't beat yourself up about not being a better or different person."
A good, intuitive therapist can figure out which approach will work with which patient and use their authority to get the patient to buy it. There are no doubt lots of other ways to "trick" people into thinking differently for their own mental health. Your friend or neighbor won't have the authority to get you to do so, however. Investing a lot of time and money to talk with a scientifically certified "expert" is probably the entry price of establishing the patient's "buy in" to the advice.
Re: inner monologue.
OTOH, talking to yourself should be fundamentally different from talking to anyone else and thus not quite comparable. If all you do for problem solving is talking to yourself, you can never get a fresh perspective on your problems, and at worst you get into an emotional feedback loop that has no outside corrective - youre going in circles.
OTOH, there is such a thing as rubber ducky debugging. You have a seemingly unsolvable problem, and you explain the problem in detail to a rubber ducky - either a literal rubber ducky or other inanimate object, or a figurative one such as a passively listening coworker/therapist. As you explain the problem, more often than not the solution will just pop up in your head despite you having received no pertinent input from outside. The solution was the problem analysis we made along the way.
Personally, I could vouch for either being true as Ive experienced both. So are they independent of each other, not mutually incompatible as they might seem? Are they true to begin with?
I've definitely experienced both. I have a constant inner monologue, I get into emotional feedback loops that take me in circles, and lately I've made a conscious effort to use something like the rubber ducky approach (without an actual object), where I question my inner monologue, playing devil's advocate in whatever way occurs to me. How could this be looked at differently, how would so-and-so I respect approach this issue? That helps to a certain extent. I've talked myself out of doing stupid things, figured out ways to solve problems, and have gained a better understanding of how I tick. It also helps, though, that I have supportive family that I can bounce my musings off of and get their perspective.
When people ask how to pray, I often hear the advice that you should always pray out loud. The reason given is that if you pray in your head it's indistinct. You don't actually have to take those thoughts and put them into the physical form of an audible sentence. By praying aloud you make your thoughts, feelings, and desires objective and observable to yourself. I think the same is true of what you describe. If you're talking about a problem to yourself in your head you can let all sorts of details fall by the wayside. You don't need to think every word exactly as you would if you were talking to someone: words and concepts get mushed together in your mind, and you often make assumptions without thinking about it because the gaps in your logic are papered over. It's like imagining a house you want to build vs actually building it: if something in your mind isn't actually stable you won't find out by thinking about it over and over. Instead you'll realize your mistake when the house you're trying to build keeps falling down.
Years of therapy and also married to one. Here’s my take: rich people can afford better therapists. Psychologists who take insurance are either new to the profession, or not terribly effective and need the network to get new clients. Which is to say, if you have the money and the time, you might benefit from individual therapy. (Basically the worried well, sancerre crowd.) Cheaper and far more effective are therapy groups which help create accountability and community.
Boy was this a timely post for me. Just today I got off the phone with a social worker where I'd discussed my new job and my concerns about how long I'll be able to keep it. I've been struggling with issues of productivity in my personal and professional life and I'm considering therapy as a result. I've always thought of therapy like medicine, you take it when there is something wrong, but unless you have a "chronic" condition that will never go away, a healthy person should be able to function without it.
Therapists have nothing on receptionists. I have over 15 years of front desk staff experience, mostly acquired while getting a PhD in something else. It's crazy what people will tell you about themselves when they realize you're a captive audience. Not only that - they come back regularly. Twice a week sometimes. And often they repeat the same stories about their lives, over and over. For years I felt bad for these people and thought they just needed a listening ear, so my personal policy was to give it to them. But then weird things started happening.
A word to the wise, if you're thinking of getting free therapy from a receptionist: Don't pick a receptionist at a place where you work/study/live or otherwise hang out regularly. Receptionists know, see, and hear EVERYTHING, including things about other people that you may be talking about in your free therapy sessions. In two different cases, I had "regulars" who were around the place so often that I could watch how they interacted with others in real settings. Each of them was consistently misinterpreting reality in different ways. Person X was absolutely convinced that Person A was madly in love with them, when they clearly weren't, and Person Y was absolutely convinced that Person B was out to get them, when they clearly weren't. Again, two different people, each of them giving me weekly reports on situations that - as I could see for myself - were just persistent misinterpretations. No doubt a real therapist would say something interesting here about how misinterpretations arise from projections of desires or fears or the id or what you had for lunch; I don't know anything about that. I just know that these two people were clearly wrong about the things they were agonizing about.
(This shook my faith in the therapy profession as a whole. Assume most therapists don't have the advantage of being receptionists and thus actually knowing about the real settings their clients are in. They depend totally on the client to describe reality. And if the client is way off base, the therapist won't know. How is a therapist supposed to help someone if they're not even in a position to say "You're completely wrong"?)
Actually, I may have an answer to that last question. Eventually I decided to gently push back on Person X and Person Y. REALLY gently, I thought. When Person B asked if cheese were around, was it unquestionably a reference to a conversation three days before when Person Y complained about the shared fridge? I asked a couple questions like that. Then I got the reactions: defensiveness, vehement repetition of the original story, signs of distress. In both cases I was so surprised I backed off, immediately. Things toned down and we wrapped up our usual session pleasantly. But then Person X completely stopped coming to see me, and Person Y took a break for several months.
Was it a good idea to try to help these people by disillusioning them? I don't know. But maybe it's a good strategy for (not-too-awkwardly) decreasing the number of people who come to you for free therapy!
This is great stuff!
You can learn a lot about a person by how they respond if you push gently at their defenses. We learn all kinds of extraordinarily polite and gentle ways to do this as therapists in a context where we have more explicit permission from the client to do it, so they don't so often walk away, but we do see deflection, distress, vehement repetition, just as you did.
Because therapy is a relationship that plays out in real time also, people tend to manifest the stuff that hangs them up out there in the world also in sessions. But also over time you hear clients describe situations they get in with multiple other people and you hear them describe their perceptions to you and it pretty quickly forms a picture of where the tangles are.
Therapists spend a lot of time with a lot of different kinds of people, listening to an incredible volume of material, and it really does give a person a kind of unique angle on humanity. You start to see patterns that you'd never otherwise get to see. It sounds like you got some of that in your role as well. Of course it's dangerous to assume we have it right, but we also have ways of testing hypotheses and the client will bring back evidence of whether we were right or wrong based on how they handled something out in the real world. And then I can get a sense over years and across many people about how often I'm right and how often people surprise me and that helps me calibrate my confidence.
If people's main difficulty is interpersonal, we also get a lot of first-hand evidence to look at in the form of texts, emails, and relayed conversations that the client shares. Even when you ask someone, "and what did they say when you said that to them?", it tells you something about what interpersonal situations are like for them.
Also when you ask "have you tried this?" or "what do you think would happen if you said this?" -- their responses to those kinds of questions gives glimpses into how their inner world is structured in a way that's pretty hard to hide (if the client is not actively pretending to be other than they are, which would be a big waste of their time and money). When someone says, "oh I could never say that" and you start to inquire about the why of that, it gives still more picture.
Couple's counselors often love that they do get to engage in real time, both to see first-hand where people get hung up and to be able to help repair it right in that moment. But it's not essential to do it that way by any means.
Super interesting, thank you for the description!
Thanks, Radar! This peek inside the profession is super interesting. I wish I'd known more of your "extraordinarily polite and gentle ways" during my receptionist days. After leaving front desk work I did wonder whether I shouldn't have actually talked to a therapist just to get some advice. Some people seemed to benefit from simply having a listening ear on occasion. But others had hang-ups that were beyond me, as I found out! I also began to suspect that Person X and Person Y really didn't want help as much as validation, and I got increasingly uncomfortable with that. I'm glad that real therapists do have ways of figuring this out, even without the benefit of sitting at a reception desk!
It took me going to therapy at the age of 24 (and the mindfulness practice the stemmed from it) to realize that I'd spent the last decade of my life completely dissociated from my body. I'd lost almost all sense of interoception and emotional awareness beyond the most gross of emotions and sensations.
Yes, traditional therapy is often just "talking with someone", but it is *not* just "talking with anyone" (although this in itself is something that would be healing for a surprising number of cripplingly lonely people). It's talking with a "someone" that is trained in helping you process and integrate all your shit, and the difference between that and just talking with your average untrained person is very often life-altering.
And this is just the traditional psychoanalytic model, not to mention the huge variety of embodied and trauma therapies that do far more than just "talking"
I had a similar take to Qiaochu after reading the Sequences. I'd emphasize "solving MY problems," because school/college just teaches you how to solve "the problems" that are handed to you. And when you're surrounded by people in an identical situation to you, you don't even need to solve “it’s cold outside,” because that's already covered by "dress like everyone dresses," a subset of "blend in with your perfectly homogenous peer group."
Rationality woke me up to the fact that actually there are problems that only I have, or problems that only I can identify, and I have the ability to both name them and apply myself to solving them, and if I don't then maybe no one else will, and there are $100 bills lying around everywhere, etc.
So that's why his take makes sense to me, even though we both probably appeared to have plenty of agency before we experienced those psychological changes.
I don’t know that this post delivered on it title (though I enjoyed reading it): Men Will Literally Have Completely Different Mental Processes Instead Of Going To Therapy
Was thinking maybe this was going to be more about why you therapy has evolved to favor techniques that work better for women than for men?
I think it's parodying a meme in which people say men will literally do X rather than go to therapy. But it sounds like the reference isn't as well-known as Scott thought, judging by the number of commenters who don't recognise it.
Agreed.
There's nothing wrong with some niche humour, but I'd urge people to add explanatory notes for a wider audience. (I wonder if the 'Know Your Meme' website explains this one.)
In this case, the niche is 'being very online' (perhaps especially on Twitter). I wouldn't want to promote the idea that this is a good thing, and that people outside of it are missing out.
Yeah it was just presented in a way that didn’t make it feel like a meme. But I should have done some poking around.
The first time I saw a professional therapist as an adult I was maybe 22. Which is almost exactly 20 years ago. I feel like the trend has become less male-friendly, but I encourage male friends to see therapists regardless. You have to try harder to find someone that won’t tell you all of your problems are because you’re male, but once you do your chances of having success with a therapist are pretty good.
Note that therapists are quite likely to have their own therapists. In support of the "you can't tickle yourself" argument.
I wonder if you could tickle yourself if your corpus callosum were severed?
Also being in therapy ourselves helps us separate our stuff from our clients' stuff which is important to doing the job well.
It used to be a requirement of most grad programs that therapist trainees be in their own therapy (different from clinical supervision) but that requirement has been abandoned so that you can't assume anymore that therapists have ever sat in the client chair.
I personally wouldn't trust a therapist who hasn't done their own therapy. It can create the sense in the therapist that therapy is for other kinds of people. I can't for the life of me imagine what motivations would sustain a therapist in this rather demanding and ambiguous career if they hadn't themselves experienced substantial benefit from therapy.
I spent a few years volunteering online on an emotional support site, and was quite popular with people coming back all the time and swearing how helpful it was, even though it was basically just active listening: empathizing, summarizing, asking questions without a hint of judgment. And yet when I tried to have someone listen to me, there was zero benefit. I felt nothing of what I preached to other "active listeners" that the person on the other end would experience. My now wife whom I met there was wildly more successful and popular, and, years later, is still being remembered and missed, and the guides she wrote are still in use. And yet she did not benefit from being listened to, either. Well, until she talked to me, I suppose, since she kept coming back, though not without an ulterior motive. But still, it is very much possible to help people quite successfully by just chatting with them, without ever feeling helped while being on the other end of such a chat.
So yeah, I fully developed the sense that "therapy is for other kinds of people".
I tried a professional therapist once or twice, and while it was a bit of a relief to vent there, and maybe get some advice on basic relaxation techniques, the experience was basically the same: therapy is for other people.
Incidentally, I had the same experience with hypnosis: I have been able to put willing subjects into trance pretty quickly and reliably, but was never able to go there even with a professional hypnotist. Which is kind of sad, I'd love to experience that feeling.
It makes sense to me a person might decide that therapy is not for them. It doesn't make sense to me that that person would choose therapy as a career therefore.
Hmm, I felt a profound satisfaction from helping others. If I did not already have a career, I would have seriously considered spending a couple of years getting the credentials required to do it professionally as a clinical counselor. But who knows, if push came to shove, maybe I wouldn't have.
On a kind of related subject, I am a teacher whose style of teaching seems quite effective, I usually have very positive reviews from the students, but when I go to a training course I hate to be taught in the style that I am using.
To me the reason to go to therapy semi regularly (in addition to reasons posted here) is simply that I've had a history of sudden depressive episodes, and maintaining the relationship means that if that occurs I will not need to start "from scratch" as I have in the past. Of course, this mindset and discipline means I'm unlikely to have an episode like that but sometimes tautologies emerge from this kind of process.
It seems extremely likely that most if not almost all people can, in principle, benefit from talking things over with someone else. Why not? We're a very social species -- it's no accident we have this incredibly sophisticated apparatus for communication -- and we would probably all agree *harm* can be done by having the wrong kind of conversations with the wrong person, so why not good done by having the right kind of conversation with the right person?
But what I would say is the $25,000 Crocodile Dundee[1] question for a lot of people is: would the chances of a positive outcome be substantially improved if I talked to a professional, instead of to my friends, a 1-800 phone pr0n number, Eliza, random trolls on the Internet? Is it possible in principle to train someone to do significantly more good than average when talking things over with troubled people, and does it actually happen in practice?
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[1] Because in the eponymous movie the Croc when told about a NYC woman who was going to therapy to talk about her problems responded in surprise 'Hasn't she got any friends?'
Is there a type of therapy that just consists of working through a remedial education on every micro-soft-skill you could potentially be missing? I wonder how effective it would be if given to the people looking for the more regular types of therapy.
An obvious comment: Remember Scott's take on Jordan Peterson? https://slatestarcodex.com/2018/03/26/book-review-twelve-rules-for-life/
I quote as appetizer: " IV. Peterson works as a clinical psychologist. (...) Much of what I think I got from this book was psychotherapy advice; I would have killed to have Peterson as a teacher during residency. (...) Jordan Peterson’s superpower is saying cliches and having them sound meaningful. There are times – like when I have a desperate and grieving patient in front of me – that I would give almost anything for this talent. (...)
So how does Jordan Peterson, the only person in the world who can say our social truisms and get a genuine reaction with them, do psychotherapy?
He mostly just listens: (...) -end of quote - now you get to that link and read up! :) btw: was the first text I ever read of SSC/Scott, following a quote I found somewhere - a lucky day, if ever there was one
There is a huge skill gap between the median software developer and someone in the top 1 percent. I expect the gap among therapists to be even larger because brains are more complex than computers and don't give as much clear and immediate feedback. So I don't think it's just the patient but also the therapist who determines how effective therapy is.
Therapists aren't really trying to understand brains though. Lord knows psychological therapy wouldn't exist if it depended on therapists knowing what firing pattern of her 80 billion neurons was specifically responsible for Stacy's feelings of inadequacy and knowing how to directly manipulate said neurons through conversation.
You write a lot of comments that are specifically hostile to women. What’s going on in your life, Brett?
As a retired CB therapist my experience was like yours that about 50% of my clients would achieve a satisfactory outcome. There is a movement within my former profession that the relationship is everything, but I note that the average rate of success still remains around 40% for therapy outcomes.
My client's feedback was pretty consistent. They thought I gave hard love. Tough, but practical. Those that said that did well. My other clients often complained and wanted a different therapist. They didn't do well with me.
Unlike my more touchy-feely colleagues, I was happy enough with this, because as my Isaac Marks said, the therapeutic relationship is not sufficient unto itself to effect change. Have being first taught under Prof Marks I tend to concur.
That's not the current flavour of the month for evidence based medicine in Britain, or anywhere else AFAIK, especially with programs to teach people scripts tailored to specific client problems by using actors for example. I understand that good results were achieved, and using unemployed actors is cost effective, but my intuition tells me that if this is so, then what is it that makes cognitive behavioural functional analysis useful if it can be delivered by rote?
It nags me that that therapy can be reduced to scripts, because while I have script routines/approaches to client problems, I also make use of my ability to think outside the box too. Maybe I'm just deluded about that.
With regards to what is often called the worried well; those people with the need to seek reassurance from health professionals, my answer would be blunt. Reassurance doesn't work, because if it did then the clients wouldn't keep returning for reassurance.
Sorry, not sorry, but as you may have guessed my training emphasized behavioural modification, though I also took a lot of course with Padesky, so not a purist about this.
Though it sounds like a cop-out, having worked in the metal health sphere for a while now it does seem like the primary predictor of outcomes is if the client wants to change. Certainly some people do want to change but have a bad therapist, but is more common that someone is willing to try therapy but not willing to change anything about themselves, even just their perceptions of themselves. And if someone doesn't want to change there is nothing you can do to change them. There's a level of humility required to get a lot out of therapy. You have to follow Peterson's Rule 9: "Assume That The Person You Are Listening To Might Know Something You Don’t". That can be a hard step for people! It was certainly hard for me. There's a lot of pride that can be a major obstacle: the kind of pride that prevents you from taking what other people have to say seriously if they're telling you something you don't want to hear.
This is a good illustration of why progress in mental health is so much harder than progress in physical health. If a medicine kills a virus, it will kill the virus, whether the patient wants it to or not. If you want change someone's outlook on life, they have to work with you or it won't work at all.
Also sometimes you have one little problem that you assume means you are irremediably broken, until someone comes along IRL or in a random internet forum and you realize everyone else got it. I have a friend who thought she was a horrible person for having intrusive thoughts until I reassured her that it was normal and something everyone had. I also heard a first hand story about a girl who thought she was dying until someone told her that periods were a thing. And there are phenomenons of rural families where no one ever goes to college, until one person does and suddenly half their cousins start to want a higher education too. Maybe sometimes you just need reassurance that everything will be okay.
This seems like a clear case of one man's medicine being another man's poison.
Can it be that people with a reduced capacity or habit of introspection can benefit immensely from outsourcing the job via therapy, while people already living too much in their heads, already too stuck in their own mental loops or even already too self-absorbed can actually be hurt by therapy (or become *pathologically* self-centered and narcissistic and unable to see anything beyond themselves, as I have seen firsthand), and in these cases of the already excessively self-reflected, "men will literally go outside and fix motorcycles instead of going to therapy" is 100% the right thing to do.
I think an important factor in the variance of therapy outcomes is that many (most?) therapists are bad.
I got, I think, what many people describe getting from therapy, from joining a discord server full of like-minded people that happened to contain a decent number who were older than me, and had been trial-and-erroring psych solutions longer than me, and could offer guidance about what to maybe trial first to get good results faster.
I had seen four therapists and two psychiatrists before joining that server, and all of them rank in benefit to my life below that discord server, my countertop dishwasher, and my toothbrush. Some of them were outright negative in benefit by themselves, most of them were absolutely negative when the costs in time and money are factored in.
I personally attribute most of this to the ableism inherent to the therapist selection process. The skills needed to become a credentialed psych professional are exactly the kinds of things I was up against a wall about, and every single one of them reacted to my problems as if it was impossible for anyone to have the struggles I was having, they did not appear to have any of the problem-solving thought-skills you describe, and could at best offer the empty encouragement that it was obvious I was easily capable of the things I had just described struggling with. One of them said, verbatim “will it really sounds like all of your problems are psychological” and that was, the END, of their insight. All they had to offer. Nice people, empty heads.
Interesting that you write your perception of therapists is they're high functioning. Here in Eastern Europe, the (accurate) stereotype is that people become therapists as an outgrowth of becoming interested in psychology to deal with their own issues, of which they have an above average load. One way I heard it put is that therapists are people who need a psychiatrist.
Necessary context is that the professions are strictly divided here, so a therapist is a person you talk to, and a psychiatrist is an actual doctor who can prescribe medication. Not sure how it is in the US
Also possible that it is possible to be high functioning relative to me (at, specifically, careerish stuff.) while being low-functioning relative to other professional types.
It is also divided here, and credentials are not even strictly necessary to label oneself a therapist in a lot of places. but all of the ones I tried had at least college degrees. (in my area, the other options all involve crystals or Christ)
Crystals have been making their way into the offices of even college-educated therapists here.
On the autism-schizotypy spectrum, the people who self-select to be therapists are definitionally susceptible to astrology, crystals, Jungian woo woo and all the gamut of overmentalistic cognition, so this is not surprising. The interesting question is how a healthcare system may protect against that, given that it tends to go hand in hand. Otherwise, we'll end up with literal shamans.
Here, you can't be a therapist without a college degree, but people circumvent the licensing requirements by just calling themselves "coaches" or whatever. Obviously, those are even worse, but even the college educated therapists usually need a psychiatrist.
Every human and human situation is different. It's a dangerous thing to profer advice to someone. And to pay for it! Poo hoo!
I dont doubt that there are some areas in my life that could benefit from me hearing something pretty basic. But what I do doubt is whether I would be willing to listen to someone telling me one of these basic pieces of advice. I think often once I'm ready to hear it I will also come up with it pretty soon myself anyway.
Personal experience: I lack internal monologue and I achieved huge progress in functioning with therapy (ACT) in very short time.
Yeah, I never even understood the basic idea behind therapy — if thinking about my problems could help, it'd have done so long before I went to therapy.
I went a few times just to see — well, more because everyone kept telling me to try it — and yep, it was exactly as useless as I expected. The problems and solutions were obvious: it was my willpower and emotional state that stood in the way, and no words or thoughts could change them.
One of the things people 100 years from now will consider our embarassing blind spots is how we call "thymic health" issues that are fundamentally about hormones and metabolism "mental health" issues. The mind is where a bunch of the more noticeable symptoms manifest, but it certainly isn't where the problem is, nor where cures can be applied.
I remember seeing a therapist and always feeling bad when I left. Then getting through my week to go back. It seemed like a goal I was not moving forward with except I was running out of weeks until the end of therapy. With feeling so bad, I decided NOT talking to a therapist felt better. I found an online group beneficial. That way I could write at any time of day or night. I found the typing itself got out the energy and bad feelings. And reading about many others with similar, or worse, situations helped too. All on my own schedule and when I needed it.
Also, even if you know how to do the required introspection yourself, paying for a therapist is committing future-you to actually putting in the time to do the work.
It’s like going to the gym (or maybe paying for a personal trainer) vs. just working out at home; many find it’s much easier to blow off the latter, even with the best of pre-registered intentions.
I hesitate to mention this, because in the video the analogy is from, the idea that's being compared is specifically political, and I think it under-credits more thoughtful people from the side of the political spectrum who are being criticized. But, well, there's this video, "I Hate Mondays", which is basically explaining that a move that gets used in politics, to avoid engaging with uncomfortable thoughts about a problem, is to treat the problem as if it were something inevitable -- as long as you have a day or two of rest, the day when you go back to work will always be a bit of a drag. You could change exactly which day that is, but work has to get done _some_ time, and so well, Mondays, whatchagonnado? We can gripe about them, but that doesn't mean we should try to change anything.
The criticism is that people often sweep problems into this category -- things that you can gripe about, or in some cases even sincerely feel sad about, while still considering it a waste of time to try to _do_ anything about them -- even when there are actually things that _could_ be done, because those things discomfit them. The video poses this as being a common pathology of conservatives, but one might just as well look at liberals whose mental processes go skating away from policies that might address homelessness when those involve deregulation, or reforming California's notoriously terrible CEQA. One of our local Sierra Club chapters has recently taken up a position _against_ streamlining CEQA review for bike lanes and sidewalks. Clearly the best way to protect the environment is to make it prohibitively expensive to facilitate non-car modes of transit. We must protect The Process. I'm sure that endangered wildlife will find a welcoming home in the thickets of paperwork. /headdesk
In any case, to circle back to the point: I think what your friend was saying, when he said it hadn't occurred to him that he could reason about his problems and then solve them, is that he had been trained to make this move almost reflexively, about anything bad. Thinking about bad stuff is uncomfortable. So just tolerate it, be stoic about it. You can't _do_ anything about bad stuff anyways, trying to just means spending more time with your mind in a state of discomfort.
I think you’re on to something. I’m not sure if people do the sweeping because it’s uncomfortable to consider solutions or engage in change. But I think there’s a deep loyalty for some people to a concept of personality as inviolable or as something to be accepted and carried rather than altered. Framing an interpersonal situation as a problem to be solved was utterly out of bounds for some people (even recently, 1980s).
I am not sure if the current framing habits are actually any good. I’ve had a range of therapy experiences. I was totally unable to put certain things into words for years. Talk therapy didn’t address those issues. I still resist considering myself in psychology terms; some of it is close enough to be interesting, some of it is just kind of made up as far as I can tell. So I sympathize with the writer who found themselves realizing they had a personality. There’s a framework there and if you can get on board with it you can experience help from the helpers, or “reason” about and “solve” some personal problems.
I spent all day trying to find a phrasing for this and I didn’t really. “Shared third eye” was as close as I could get. There is a way people can get on the same wavelength and thoughts and concepts become visible in conversation in an almost tangible way. As screens proliferate I think humans are losing that skill - not permanently, but just not knowing it’s a thing. It requires a type of mutual attention. Feeling a shared intimacy of personhood really changes one’s ability to see oneself as an atomized operator and analyze and choose individual actions to attain individual results. I think some of the unfamiliarity is the transition of society from the shared to the atomized.
As someone who went to graduate school to be trained as a therapist, I was planning to jump in to offer some alternative takes on therapy as a profession - both how it is more than supportive therapy/talk therapy as well as the trends/flaws/susceptibilities within the industry that have contributed to many individuals' negative outcomes - but Radar has already covered the subject eloquently and likely far better than I would, especially since they've got real-world experience backing it and I segued into higher education afterwards. Instead, then, I'll offer a metaphor for how I always viewed supportive therapy specifically.
I would equate supportive therapy to getting dressed in front of a mirror with someone else giving their opinion on your outfit. Some people have an innate (or have developed over time) a sense of fashion and are aware of their own personal tastes and can get dressed just fine without a mirror or any outside assistance. Some people have a good sense of what they like but also want to double-check themselves, and so can get by on their own as long as they have a mirror to take a look at themselves and double-check their outfit before going out. Others (whether because they haven't developed a personal sense of fashion or style or are just seeking some outside validation to make sure they're in step with their local groups/social circles) like to have a third party offer their advice on what is working with the outfit, what isn't, and offer suggestions or changes as necessary.
I think that goes a long way towards explaining the variance in the efficacy of supportive therapy! How much bang you'll get for your buck depends on how much you have access to an empathetic ear outside of therapy, your ability to self-reflect, your own strategies and methods for processing your feelings and the various day-to-day events of your life, and how capable your third party is in helping your evaluate (or re-evaluate) the approach you're currently taking. It's definitely not necessary for everyone, and the industry is definitely saddled with its share of individuals who are doing more harm than good (whether properly credentialed or not), but I don't think the variance is all that mysterious.
A difference I found in therapy is: when talking with friends and loved ones about sources of conflict, hardship, whatever, I frame it in a way that is attempting to garner sympathy. When talking to a therapist, I frame it in a way that is attempting to be constructive and resolve the issue. Sometimes just framing things in that new way caused me to realize I had methods to deal with these issues already, but wasn't consistently applying them.
Doctor: Do you hear voices?
Patient: No never. Not the way you mean anyway.
Doctor: Hmmm.... that's concerning. You should talk to a therapist.
Patient: What! Why?
Doctor: Well hearing voices is healthy. So...
Patient: Really?
Doctor: Yep, just as long as the voices aren't, you know, utterly insane themselves.
Am I the only one who read the headline and thought that it was going to be something about gender differences in therapy participation?
Me too. Turns out to just be a reference to a meme. Go figure!
https://knowyourmeme.com/memes/instead-of-going-to-therapy
Thank you for posting this here! I was confused.
In my own experience therapy is really helpful to time-bound lines of thought that otherwise become dysfunctional.
For instance if late at night i start falling into a depressive thoughts rabbit hole in which I question all of my life choices I can defer thinking those thoughts to the next session.
I also have a relative has a really bad addiction and has consistently harmful interactions with me, and i can cope as long as I can vent my frustration with someone, but I don't want to berate my friends thrice a week telling them how a person they don't even know has found a new way to get at me.
I don't go to therapy to be given advice (clearly), nor do I go for reassurance. I simply enjoy and benefit from setting aside an hour and having someone help me organize my thoughts; I'm paying for time outside my own head. I can't do this with a friend because they're too quick to try to advise, or to be indifferent. The therapist remains objective yet engaged at the same time. It's moderately helpful.
I would definitely benefit from talking to someone about my issues in order to think through them more clearly. I have inner monologue but there's some ugh field around some of my issues; and also having to explain stuff to another person can help when I'm stuck even when there's no ugh-field (https://en.wikipedia.org/wiki/Rubber_duck_debugging).
But this requires me feeling that the person I'm talking to cares, is interested, actually follows, and is open and not trying to fit into a model of a healthy mind. The couple of times I tried therapy, this didn't happen. I find the relationship with the therapist unnatural, unclear, uncomfortable. I don't know to what extent I am supposed to give in to their expertise and "treatment" and evaluate the results months later, or treat them like paid professionals that I can use to help myself by taking the lead.
It is important that the therapist care, be interested, pay close attention, and is not just trying to jam you into some box of "normal" or any other kind of box. It is important that you like the therapist genuinely and that you hang in there long enough to trust them enough to care what they think and to respect them.
The relationship is somewhat unique in all of society and so it can feel uncertain and unclear at the beginning -- "what are we doing here?" and "how do we do this?" Those are questions you get to talk about with the therapist.
I would say there is no need to "give in" to their authority. It is a collaboration where you have room to get clearer and clearer about your goals and the therapist helps map out options for moving towards those goals and then you try various things out (in session and in-between sessions) and you bring that evidence back and explore it some more to see what helps and what doesn't help.
I do think it's rare for people with long-standing issues to experience huge change in just a few sessions and so often you do need to be willing to commit to trying it out for a few months before rendering a judgment about whether it's overall doing what you need it to. But also, one should have the sense early on -- within the first three or four sessions -- that it's helping at all. The first one to three sessions is a lot of gathering background, but by the end of the third session or start of the fourth session (and often sooner), one should have the feeling that this seems like a helpful thing.
Different people are able to take the lead in sessions more or less depending on who they are. Therapists often like clients who can take the lead because it's easier for us when people know what they want and where they want to go, but it's also not essential. Even if you are able to take the lead, it's still a collaboration, a conversation between two people. Sometimes people treat therapy like there's not another person in the room and they just unload and could have done that in an empty room. It's fine if that happens sometimes, but if a person finds themselves doing that in every session, they are missing an opportunity to learn (I know, I did that myself as a client for a long time).
I see, thanks
Just came here comment on the insanity of the lack of studies
My therapist (rogerian) is basically someone who I pay to listen to me. All they really do (except on one quite funny occasion) is basically paraphrase what I've said back to me. Over time this basically helps me narrow down themes, things I'm actually unclear on, things that I'm hiding from myself and others etc.
You can basically do this with journaling etc. But I don't trust myself to accurately reflect myself.
You can do this with anyone really, but friends and family are often the people I'm talking about so that's not really possible. Friends and family also have years of ideas about who I am that could get in the way.
My therapist is just a relatively neutral sounding board that helps me to uncover the layers of things obscuring the path forward. The quote unquote breakthrough I had was basically me slumping into therapy, flopping to the chair and being like "This is all the stuff I need to change, I've been hiding it by xyz, you have known this since our first session because its painfully obvious from the outside isn't it?" and them basically smiling and nodding.
For me, it's a combination of "you can't tickle yourself" and the old adage about how with prostitution, you're not paying for the sex as much as you're paying for the prostitute to leave afterwards.
You just can't call yourself out on your own bullshit as effectively as someone else can. Or, even if it is something you're already telling yourself, it can be helpful for someone external — who isn't meaningfully in your life — to back you up and help your homunculus lean on the right levers.
And there are certain things you can't or shouldn't put upon the important people in your life, at least not unfiltered. With therapy, you can just say the most unfiltered version of things without worrying about judgment or eroded relationships.
Lastly, I find couple's therapy really helpful in that difficult conversations can be moderated and steered back towards productivity, and it provides a sort of "disinterested third" who can provide accountability for partnership goals.
Someone else brought up priests, here, and I find that really interesting because I do think that therapists can be like secular priests, and this could be a good or bad comparison, but I take it as a negative...
you could say that a priest's job is to selflessly help his parishoners, but more often than not you can find examples of priests abusing the power imbalance in some way, or using their position as a way just to rag against all the things they hate... rather than be a holy, good, nice 'man of ogd', like you might say the job description entails... because descriptions rarely capture how something plays out in the real world.
The same thing with therapists, but a different set of people might be fooled by the same behaviour that corrupt priests exhibit, but because it is not about 'religion', but instead framed as 'laws of psychology'...then different people might take it seriously.
A lot of people are more interested in dogma, than actually discovering more about the universe... and you might say 'honoring God', if they're priests...
The best the therapist I ever had was a psychiatrist who kept telling me how f**ked up my life was. Every session with him made me more depressed. Moreover it made me angry, because there were a lot of wonderful things that I had experienced, and he didn't seem to be acknowledging them (I just wanted advice about how to get through a particularly stressful time in my life). I finally lost my temper with him. I shouted at him, "My life isn't f**ked up!" He smiled at me indulgently and told me the session was over. I walked out angry, but in defense of my statement I kept thinking about all the cool and fun things that happened over my life (up to that point). Then I realized that my life was actually pretty good, and whatever problems I was having weren't that big. And I realized I didn't need his help. I never went back. To this day, I'm NOT SURE if he provoked me on purpose to get me out of my rut, or whether he really thought that I had messed up my life. Either way, once I started looking at my situation in positive light I never needed counseling again.
Peter D. Kramer in one of his bestsellers, forget which, talks about this one therapist who made a breakthrough with a patient who was having persistent slightly paranoid thoughts. Legions of therapists had tried to get the guy to look at the evidence clearly, in hopes he would see his suspicions were unfounded, or explored with him why he might be having these thoughts. Nothing worked. He' d become immediately defensive, dig in, et cetera.
So the guy is talking to our hero one day, and he wanders off into a slightly paranoid fantasy of what his co-workers meant when they said X or Y, and the therapist leans forward intently and says "Those bastards!" The patient is totally taken aback, and starts explaining why the *therapist* might be mistaken, and this is the beginning of real change. If I recall correctly, Kramer said this was an exceedingly risky strategy, but he admired its chutzpah and the fact that it actually worked.
What does the title of this post have to do with the content of this post?
I’m honestly shocked to be reading this from a rationalist and psychiatrist. Therapy provides patients the framework to think about mental health and the vocabulary to talk about it. It is the only chance many patients will ever have at reconciling the “why” behind their illness. I am curious why the rationalists on this substack would cite inconvenience or "just use a friend" as reasons to shy from the chance to test their mental constructs of the world by an objective party who will challenge their consistency/accuracy. Am I missing something? Why all the hate?
Fully agree.
I'm a psychologist and I don't think therapy works very well. There are a number of reasons for this, but its not "hate."
1. We have several generations of people who are resistant to insight-oriented treatment, because cluster B personality traits are now so prevalent, they are almost normative.
2. Genetic expression accounts for a huge part of human behavior, and those people who develop personality and other psychopathology have behavior patterns that are almost impossible to dislodge. Other biological factors are in play as well.
3. Severe mental illness (psychotic and bipolar processes) get the biggest bang for the psychotropic buck, because they are totally organic issues. I have patients come to me who have pre-existing diagnoses like Bipolar I, who have been stable on meds for some time and I can't tell they are Bipolar.
4. Most therapists have no idea what they are doing. They read a book on some modality they like, and it is the hammer to everything they see that looks like a nail.
5. A person who walks into a therapists office with the attitude of "what is wrong with ME" is like a unicorn. I have never seen one. They all come in wanting to change everyone around them, which is not possible.
Thanks for your insight. #1 is of great interest to me, would you be able to explain what you mean by the increased prevalence and normalization of cluster B traits? I am very curious to see if there is actual data on this beyond anecdote. I have heard that classic NPD is resistant to therapy, but that some subsets of cluster B patients, such as those with with narcissistic "fleas," may actually derive a lot of benefit. Has this your experience in practice?
#4 is also intriguing and unfortunately makes a lot of sense. Can you please elaborate on which modalities are more/less effective? Wouldn't a therapist want to have multiple modalities in their tool belt?
I might suggest that -a- reason (not THE reason) for the popularity of "talk it out" therapy is the decrease in personal relationships.
I was in an isolated place and time in my life going through a divorce, and going to a therapist was helpful, just to unload a little. After about a year, the initial trauma was, well, scabbed over if not healed, and at some point I realised that continued progress would really depend on me making significant changes in myself and my life, and quit going.
I buy the idea of the therapy I had 2 years ago, during a severe bout of anxiety & depression, as unlearning a set of rules I had about myself & replacing them with more useful ones. There was nothing mysterious about it per se, although the therapist was remarkably good at treading the line between being a faux parent and a kind of dispassionate mental mechanic. My default state remains 70% actively happy, 20% neutral & 10% confused & anxious. Prior to this I was 70% confused, anxious & angry & 10% happy but waiting for happiness to dissipate. I doubt I could have got here without 2020’s 6 months of weekly Zooms with her.
Is it possible that therapy has very little effect and people are just believing that it does? For example, could it be possible that without therapy, QiaochuYuan would have been the same successful person, but would have nothing to attribute his success? A bit like billionaires who credit hard work for their money, while it's usually just luck?
Are there some studies that prove that therapy is *actually* effective?
For all therapy in general, no. For some specific therapies, definitely yes. The studies for Cognitive Behavioral therapy are starting to look pretty good, across a wide range of conditions.
See https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3584580/
In my practice, what I see (saw, I only do one-shot evals and court testimony now) is that the evidence-based treatments worked for a while, but they did not solve the underlying issue. 6-18 months later, the client would be back with the problem simply manifesting in some new maladaptive behavior. Psychodynamic therapies work, but to do them correctly takes years, sometimes multiple sessions per week. Insurance doesn't pay for that, because they want results in some set number of sessions.
...I'm really, really glad I live in a country where "what insurance will pay for" is not the benchmark. Although we have mental health funding issues of our own.
I went to group therapy and we had a new person introduced, who among other things had anger issues.
they would start arguing with their partner about something and in the end they'd black out and become violent, and wanted to do therapy to well, stop doing it.
I asked if they ever tried to just stop arguing and go for a walk until they calmed down when they felt they were becoming agitated, and they just looked at me like I said water was dry and the ground is lava.
they said that "not having arguments that lead to violence" had never, ever crossed their mind, and were flabbergasted at the mere thought of "just stop doing that bad thing that leads to even badder things".
I want to throw a big old culture clash into this discussion.
I've lived big, big chunks of my life alongside two groups: jewish academics, and old fashioned Chinese farmers who happened to become engineers during the cultural revolution.
The jewish academics can't get over the idea that the old fashioned Chinese farmers who happened to become engineers during the cultural revolution have precious little to no self analytical habits.
The old fashioned Chinese farmers who happened to become engineers during the cultural revolution can't *see* therapy, or self analysis, or a robust inner monologue. It all might as well be the seventh ultraviolet shade of purple, or the color greb.
I'm sorry if this ruffles anyone's feathers, and I welcome if someone wants to offer a different experience.
This really speaks to me. I've struggled with fairly severe depression my whole life, as well as anxiety and addiction. Due to the nature of my work I couldn't get therapy for a long time, but that recently changed and I started going. I've probably been in it about five years. I've tried about five therapists in that time, almost always giving them month's worth of time to give it a valid try.
Honestly, it didn't help. Pretty much at all. I blame myself. There's something about me, even when I have a realization it doesn't do anything to persistently change my mood.
It's so frustrating because I know *so many* people who talk about how much therapy helped them. Which really makes me wonder what's wrong with me.
The things that have helped in that time:
1. Cymbalta was amazing at first, then over the course of a year or two the efficacy went away.
2. TMS was amazing for a while as well, although its effects are waning recently as well.
Has anyone read "Psychology Gone Wrong?" I hear it's a great book but a poor translation. An article based on it in Psychology Today basically said a good friend can fill the role of therapy just as well, that it's merely being able to talk through issues with someone empathetic.
I spent my time in the trenches doing therapy, including everything from manualized treatment protocols to "supportive" therapy. I don't think it works much for a lot of reasons, but I love being basically a forensic psychologist only now.
The main benefit I derive from therapy is having someone to talk to. Full stop. Someone who will listen with their undivided attention, and be genuinely interested (or very convincingly feign interest), and understand where I'm coming from, and be sympathetic and non-judgemental, and not at any point expect me to reciprocate by listening to their own brain dumps. Regular people are terrible at the first few things (I don't have a single friend or relative who's consistently capable of even one of them), and it would be unreasonable to ask anyone who isn't trained and getting paid to do that last part. So therapy is my only avenue, and it's a really important one. Someone to talk to. As long as I have that, I'm fine. It gives me strength.
Since this is the part of therapy I find helpful, you can imagine how detrimental it was to my mental health, and my life in general, when I aged out of the therapy programs that will let you see someone once a week indefinitely, and found that the remaining free/low-cost therapy programs only do goal-directed therapy, where you focus on solving a specific problem or learning a specific skill, and generally you're limited to about 10 or so sessions on the presumption that you will have solved the problem or learned the skill by then (and if you haven't then tough luck). I don't get anything out of this kind of therapy. That's not what I need. It's not like I don't know what I should be doing. If I could just up and do stuff just because I know I need to do it, I wouldn't need therapy in the first place. I don't need someone to give me goals or skills. I just need someone to listen, on a regular basis, so that I will have the strength to do those things myself.
I entirely belief that talking to a right person at the right time can change one's entire world, but I don't believe that:
1. Therapists are actually trained and have credential to be that person
2. It's worth >$100 to try to test that