Is it all made up?

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Potato
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Is it all made up?

Post by Potato » Thu May 10, 2018 8:59 am

Hi there,

I'm new to the forum and just trying to stimulate some conversation and discussion so I hope no one is offended by this, but lately in my work I've been feeling more and more that therapy is all just made up?

I've spoken to a colleague about this and he advised it's something all trainees go through while training because we just don't understand yet... which felt patronising to be honest. I'm struggling to see the real differences between therapies and I know that many overlap and this is why there is such an emphasis on evidence based practice but I still fail to any large gains made in services. What I do see is clients returning to therapy over and over again or in some cases life situations changing which in turn helps them feel better.

I appreciate any (helpful) thought around this.

NotReally
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Re: Is it all made up?

Post by NotReally » Thu May 10, 2018 10:32 am

I think it's certainly positive that you're reflective enough about your work that you are thinking about what aspects overlap etc. However, I'd say you've sort of answered your own question there, specifically the bit about life situations changing making people feeling better.

It was perhaps best put (to me) by a psychologist who I worked with. "Mental health is a continuum; we're all on there somewhere and so we're all susceptible, it's just that some of us are in a better place than others right now". Feeling good gives you the foundations to go on to make better decisions. It's obviously not a guarantee, but generally speaking, the odds are in your favour.

Potato
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Re: Is it all made up?

Post by Potato » Thu May 10, 2018 11:15 am

Thanks, NotReally. This actually really helped.

hawke
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Re: Is it all made up?

Post by hawke » Thu May 10, 2018 11:35 am

Wow, what an interesting conversation starter!

You talk about 'large gains' (not) being made... I think the reality of services, particularly the NHS, is that most therapy on offer is short-term. Whatever NICE guidelines suggest, services never seem to offer the full dose of treatment - or even offer people the wrong level/type of treatment in the first place. So I think it's no wonder people are walking away from therapy with limited gains, and then finding those gains don't stick. And cynically, with services being targeted by access rates and short-term outcomes, it's not really in their interests to think long-term. That's a problem with the system though, not the therapies themselves.

I think I used to separate out 'life situations' from 'mental health' - I used to justify some people understandably feeling bad because of what was happening to them, and assume that any gains from therapy were just a circumstance of timing. I now see the point of therapy as raising someone's resilience to cope with these life situations. This doesn't mean someone is 'cured' forever, but it certainly does raise the threshold for when they might need support in the future. We can also help people learn to prevent those life circumstances somewhat - so many people lack basic emotional/life skills, and I think people learn them best in the context of a supportive relationship of some sort. Therapies differ in their focus and level of direction, but they are all aiming to provide a safe space for someone to become more self-aware and then work out for themselves what changes they want to make. I think the general public have a false idea of therapy though, and so often you're battling against the 'fix me' or 'eliminate all distress from my life' mindsets.

However having said all that - the therapies (or even mental health treatments in general) we have are not good enough. Even in the tightest RCTs with strict inclusion/exclusion criteria, not everyone shows improvements. The evidence base is generally interlinked with the concept of diagnosis, which is increasingly looking outdated in the world of complex reality. Psychology is still in its infancy compared to the other sciences, and so we've still got a long way to go. At the moment, therapists are doing their best with what we've got, and psychologists are doing their best to figure out the stuff we don't know... progress is never as fast as we'd like it to be, but I think we're heading in the right direction.

Potato
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Re: Is it all made up?

Post by Potato » Thu May 10, 2018 11:47 am

I'm glad other people are not offended by this topic haha.

Thank you Hawke. Some very valid points and nothing I can argue against.

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ChrisCross
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Re: Is it all made up?

Post by ChrisCross » Thu May 10, 2018 9:55 pm

Hey potato,

I personally think you're right to point out the overlap between therapeutic modalities and, whilst I'm a trainee myself, I've also had qualified supervisors who have shared similar views. Have you looked into the common factors theory at all? Might be something that interests you!

My own take on this is that therapy "success" or "outcome" is, first of all, really difficult to define because it depends so much on the individual's goals and expectations of the process. Secondly, I'd argue that much of the change that happens in therapy is due to the therapeutic relationship - forming a real connection with a living, breathing, human-being, who validates your experience and adopts a gentle curiosity, whilst facilitating the expression and containment of feelings. I've experienced therapy from both sides and, for me, the relational aspects just seemed so powerful, regardless of the approach that was used. From this perspective, it makes sense that there would be so much overlap between therapies because essentially they are all doing very similar things - providing a safe, containing space in which to freely be with another person.

I also believe that therapy often needs to be a long-term investment for the real changes to start taking place - especially for people who have particularly entrenched patterns of relating to others and/or themselves. There does seem to be a bit of a 'revolving door' in some services, which I sadly think is because of the emphasis on throughput and short-term, sometimes manualised approaches, that might not address a person's concerns at an individual, deep and meaningful level. What we need is long-term investment in people's mental health, but of course there are so many issues around funding and politics that I won't even begin to go into.

Of course, I'm going to be biased here, and I know there are people who might disagree with my views, but that's how I make sense of it at least.

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miriam
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Re: Is it all made up?

Post by miriam » Fri May 11, 2018 2:49 am

If you read the Power Threat Meaning framework, or some of the Psychologists for Social Change stuff you'll see that whilst we can make impact by working with how clients think and behave (and have amazing impact in even very simplistic or short interventions sometimes) there are some things we can't undo in their history, or have any power over in their current circumstances that are much bigger variables.

But psychologists can and do make impact in therapy and direct work. I've really enjoyed doing psycho-educational work with parents and carers, where sometimes even an hour can help people understand something differently, and go on to parent differently and make a huge difference to a child's life. Doing a really good assessment or helping a client understand themselves can be life changing too. Naming a difficulty, and showing it is common and not someone's fault can have huge impact, as can helping to diagnose ASD, or explaining the impact of attachment and trauma to many adoptive and foster parents. I've also done direct therapy where we've gone from an incapacitating problem to a manageable problem around which they can live a fulfilling life in 4-6 sessions. I remember a spider phobic lady I worked with as a trainee who would be imprisoned in a single room by the thought of spiders, and once climbed out a window and down a drainpipe as she couldn't pass a spider on the doorframe of her bedroom and had no means to call for help without doing so, who six sessions later was able to hold a piece of paper with a spider on it, and stand still and watch when I released spiders from a jar into the carpark near her (admittedly with the plan of stamping on any that charged her way). Its a tiny thing at one level, but it made a huge difference to her life.

I have many examples I can look back on and think "I helped make a difference there", from a child who was admitted to A&E 17 times with self-harm in the year before I was involved and only once in the year after, to people who have cried and kept therapeutic letters I've written on them for months or years, or told me our work gave them "light at the end of the tunnel". Likewise people who were cripplingly socially anxious, or depressed who learnt ways to cope with it. Or children who learnt at some level that being abused wasn't their fault or a sign they were bad or broken. Our diabetes project (link) pulled 15 people out of active suicidal ideation in 6-12 sessions of therapy, and made all 48 patients referred feel measurably happier. That's got to be worthwhile.

So whilst there is some sense in which much of therapy is common sense, listening and being with people in times of need and therefore doesn't feel very skilled or specialised, that in itself has human value. To me a lot of what we do is about modelling the healthy attachments that people lack, and helping them seek out or replicate these in their own lives - which is a very essential human thing. If you read Scott D Miller's articles on super shrinks and pseudo shrinks, the model you use doesn't matter as much as the quality of relationship, and being willing to really hear what the client is saying and respond to their needs. There is a lot of snake oil being sold in the therapy world, and whilst we need to evidence our value above this, it really is a reminder that sometimes relationships and hope (with or without a placebo) are a treatment in themselves.
Miriam

See my blog at http://clinpsyeye.wordpress.com

Potato
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Re: Is it all made up?

Post by Potato » Mon May 14, 2018 9:58 am

Thank you both also. I feel comforted to know that other people have felt this way and it is ok for it all to feel a bit like common sense.

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Spatch
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Re: Is it all made up?

Post by Spatch » Mon May 21, 2018 11:16 am

I'm new to the forum and just trying to stimulate some conversation and discussion so I hope no one is offended by this, but lately in my work I've been feeling more and more that therapy is all just made up?
Beyond certain natural sciences, almost everything is "made up" including (but not limited to):

- Law
- Mathematics
- Fashion
- Ethics
- Friendships
- Money
- Your identity

In fact there is a whole philopsophical approach (Social constructionism) that posits that practically everything is "made up". I guess my question to you would be "Is this a problem? If so, why? and What is it about the nature of therapy in particular that raises your concerns?"
Shameless plug alert:

Irrelevant Experience: The Secret Diary of an Assistant Psychologist is available at Amazon
http://www.amazon.co.uk/Irrelevant-Expe ... 00EQFE5JW/

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