'Mental Health Culture Has Gone Too Far'

[Ridgewalk]

11 hours ago, liam1412 said:

 

The problem is you can't build resilience, as when you go for help, they fill you with SSRI's, and do nothing to fix the underlying  issues. 

This is the problem with psychiatry, the medical model doesn’t appear to have solution beyond medication,  its reductive. 
 

Uncomfortable feelings should be considered part of the human experience.  People aren’t going to die from anxiety. Cognitive Behaviour Therapy is more effective than meds. You do however need a qualified therapist, and the private sector is expensive. Long waiting list on the NHS I suspect.

[mhrow]

7 hours ago, Ridgewalk said:

Uncomfortable feelings should be considered part of the human experience.  People aren’t going to die from anxiety. Cognitive Behaviour Therapy is more effective than meds. You do however need a qualified therapist, and the private sector is expensive. Long waiting list on the NHS I suspect.

 

Is there any need for qualified or experienced therapists?

The world's largest and best funded psychological association published a report on this just a few months ago:

https://doi.org/10.1037/0000354-017

They highlight lots of large studies:  A cross sectional study with 1,318 clients, with undergraduate interns achieving better client outcomes than experienced professionals.  Another cross sectional study with 6,099 clients found that unqualified interns obtain the best outcomes relative to two more experienced groups.  A longitudinal study with 6,500 clients, over a 14-year period, finds that in aggregate therapists got slightly worse with more experience.  A long term study of 22 therapists from the time they were a student through to becoming a professional in their work with 4,047 clients: therapists stayed the same with respect to outcomes or got slightly worse over time.

 

They say:

Quote

the newer, more methodologically sound research does not appear to support a positive relation between client outcome and therapist clinical experience, at least as measured by years of clinical experience or experience groupings. Indeed, there is some evidence to suggest the possibility that greater experience is associated with poorer client outcomes

 

They mention only two studies where experienced therapists were found to have better outcomes overall, and the improvement was very small (d = 0.03 and 0.04).  In one case "the change was attributable to obtaining improved outcomes
only with less distressed clients", and in the other they attribute it to the exceptionally well organised practices at the therapy centre.

 

The whole article is remarkable and it's worth reading in full, but these are some relevant quotes:

 

Quote

 

In a systematic analysis of randomized control trial training-program interventions, Kuhne et al. (2019) found changes in many therapist behaviors and perceptions (i.e., facilitative conditions, conceptual skills, and self-confidence), but no changes in client outcomes. Thus, even in student training samples where one would expect the largest gains in therapist skill in achieving positive client outcomes, the results were quite modest, if present at all. These examinations of training programs are perhaps the closest test of Beutler’s(1997) above noted concerns about testing specific experiences versus simply time spent engaged in clinical work. In sum, studies employing both cross-sectional and longitudinal designs have thus far demonstrated minimal support (if any) for the association between therapist experience and better client outcomes. Further, in some instances, therapists appear to generate worse client outcomes as they gain experience (Budge, et al, 1023; Erekson, et al., 2017; Goldberg, Rousmaniere et al, 2016; Minami et al, 2009).

 

It is notable, therefore, to find that the research also shows that therapists’ confidence tends to grow over time (Kuhne et al., 2019; Orlinsky & Rønnestad, 2005). This is a troubling pattern where therapists do not become more effective over time, and may indeed become less effective, but they perceive themselves as becoming more skilled, better therapists. Further, therapists tend to overestimate their effectiveness and skill. For example, in one survey, all therapists rated themselves as “above average” (Walfish et al., 2012). Even more telling is that therapists find it difficult to recognize when their clients are deteriorating (Hannan et al., 2005; Hatfield et al., 2010), suggesting that perhaps unrealistic self-assessments stifle therapists’ honest and critical examination of their work and constrains their improvement over time (i.e., with experience).

 

Quote

The literature is clear in demonstrating that therapists do not get better over time in their ability to effect client change. This is true with respect to the many cross–sectional studies and the few longitudinal studies that have been conducted. The conclusions are just slightly more favorable with respect to graduate student training where one should expect substantial changes over time.

 

[mhrow]

Going back to the original post,  in my opinion the introduction of UBI would mean we could more easily take the time to give informal support and care to one another.

 

There's no reason to give credence to people who have qualifications, unless their profession can clearly demonstrate valid knowledge or effective skills.  The latest evidence suggests there's no overall benefit of having qualified professionals in therapy, and we might be better off if lay people were given the chance to take over these roles.

 

[Delbow]

You never hear anyone say "cancer culture has gone too far", do you? "Age-related macular degeneration culture has gone too far". "People yapping on about their heart disease, eh? I bet they're making it up".

 

But because you can't see mental health problems, it's assumed that people are taking the pish. 

 

Maybe policy makers should look at countries like Sweden, where almost no-one does overtime and workers are generally happy and productive. Ah, but executives and shareholders there don't make quite so much money and can probably only afford one big house in a nice area, so that's a non-starter.

[Delbow]

1 hour ago, mhrow said:

 

Is there any need for qualified or experienced therapists?

The world's largest and best funded psychological association published a report on this just a few months ago:

https://doi.org/10.1037/0000354-017

They highlight lots of large studies:  A cross sectional study with 1,318 clients, with undergraduate interns achieving better client outcomes than experienced professionals.  Another cross sectional study with 6,099 clients found that unqualified interns obtain the best outcomes relative to two more experienced groups.  A longitudinal study with 6,500 clients, over a 14-year period, finds that in aggregate therapists got slightly worse with more experience.  A long term study of 22 therapists from the time they were a student through to becoming a professional in their work with 4,047 clients: therapists stayed the same with respect to outcomes or got slightly worse over time.

 

They say:

 

They mention only two studies where experienced therapists were found to have better outcomes overall, and the improvement was very small (d = 0.03 and 0.04).  In one case "the change was attributable to obtaining improved outcomes
only with less distressed clients", and in the other they attribute it to the exceptionally well organised practices at the therapy centre.

 

The whole article is remarkable and it's worth reading in full, but these are some relevant quotes:

 

 

 

 

Have you ever read any David Smail? He was interesting - a clinical psychologist who nevertheless felt that most of the talking therapy industry made the mistake of locating the root of people's distress in themselves, rather than in the material realities they live in. In other words, therapists are too often (not always) trying to help people fix themselves, when what needs fixing is the world around them.

[Ridgewalk]

18 hours ago, mhrow said:

 

Is there any need for qualified or experienced therapists?

The world's largest and best funded psychological association published a report on this just a few months ago:

https://doi.org/10.1037/0000354-017

They highlight lots of large studies:  A cross sectional study with 1,318 clients, with undergraduate interns achieving better client outcomes than experienced professionals.  Another cross sectional study with 6,099 clients found that unqualified interns obtain the best outcomes relative to two more experienced groups.  A longitudinal study with 6,500 clients, over a 14-year period, finds that in aggregate therapists got slightly worse with more experience.  A long term study of 22 therapists from the time they were a student through to becoming a professional in their work with 4,047 clients: therapists stayed the same with respect to outcomes or got slightly worse over time.

 

They say:

 

They mention only two studies where experienced therapists were found to have better outcomes overall, and the improvement was very small (d = 0.03 and 0.04).  In one case "the change was attributable to obtaining improved outcomes
only with less distressed clients", and in the other they attribute it to the exceptionally well organised practices at the therapy centre.

 

The whole article is remarkable and it's worth reading in full, but these are some relevant quotes:

 

 

 

I’ve not read the reports but the premise of not needing qualified therapists to achieve better results is interesting. I’ve some experience of CBT as a psychological treatment and as a therapy it makes sense to me.  That said I think there’s as much if not more value in having good quality relationships and an attitude of acceptance of difference by professionals working in the broader mental health field.

[Ridgewalk]

17 hours ago, Delbow said:

 

Have you ever read any David Smail? He was interesting - a clinical psychologist who nevertheless felt that most of the talking therapy industry made the mistake of locating the root of people's distress in themselves, rather than in the material realities they live in. In other words, therapists are too often (not always) trying to help people fix themselves, when what needs fixing is the world around them.

I suppose that’s the thing, therapists learn and study a particular model of treatment eg dialectical behaviour therapy, CBT , psychodynamic approaches etc then try to fit a client into a particular paradigm, whether it’s helpful or not. Social and family systems are important. If you’re poor with limited economic options and in a toxic relationship for example what can therapists do ?

 

 

[Ridgewalk]

17 hours ago, Delbow said:

You never hear anyone say "cancer culture has gone too far", do you? "Age-related macular degeneration culture has gone too far". "People yapping on about their heart disease, eh? I bet they're making it up".

 

But because you can't see mental health problems, it's assumed that people are taking the pish. 

 

Maybe policy makers should look at countries like Sweden, where almost no-one does overtime and workers are generally happy and productive. Ah, but executives and shareholders there don't make quite so much money and can probably only afford one big house in a nice area, so that's a non-starter.

As a generalisation less unequal society are happier societies. Several years ago several uber wealthy Americans and their families wrote to their government asking to be taxed more. When the  gap between the haves and have nots becomes too big, it’s a threat to democracy.