Therapy Experience Associated with Negative Changes in Personality

http://www.sciencedirect.com/science/article/pii/S0092656616302410

by whitepoplar • 9 years ago

82 58 9 years ago

curuinor2• 9 years ago

Causal statement in the headline. You might think only correlational statement on paper, and this is somewhat true but it is a controlled ecologicalish study.

no random assignment.

bad temporal proximity of data gathering on personality.

methodological poking about at the badness of controlled vs observational studies. basically study recruitment as a selection effect.

maxander• 9 years ago

They do perform a statistical analysis ("propensity score matching") to try to control for off-target correlations, but its true that the entire strength of the paper revolves around this having been done correctly and it being sufficient. Given the fact that improperly controlling for confounding factors could entirely account for their data (people whose personality traits are deteriorating are likely to have some awareness of this, and therefore to seek therapy) you would think that an account of this procedure would be front-in-center of their argument- but no, all details of that step are relegated to supplemental data for some reason.

It's also worth noting that data collection was entirely done through surveys; so, another explanation could be that therapy simply made people more aware of pre-existing personality deficits, that they were then able to more accurately report.

And further, even if the results are valid, it doesn't invalidate the benefits of therapy; most therapy methods are built around helping the patient. Its possible that therapy improves the subjective quality of the patient's life at the expense of some external qualities (or pretense thereof.)

civilian4• 9 years ago

Its possible that therapy improves the subjective quality of the patient's life at the expense of some external qualities (or pretense thereof.)

That's not the case-- they were measuring for subjective quality, and it was subjective quality that declined. I posted the PDF of the paper in my top-level comment, but the Psychological measurements they were looking at in the German cohort were self-esteem, life satisfaction, and depression. The US cohort was measured for self-esteem, chronic stressors, and depression.

sctb• 9 years ago

Thanks, we've updated the headline from “On average, psychotherapy brings about undesirable changes in personality”.

KingMob• 9 years ago

Huh? I don't have access to the full article; is it about therapy in general or psychotherapy in particular?

ouid• 9 years ago

not to mention that an equally explanatory representation of the data is: "Pathological behavior is correlated with worsening pathological behavior"

curuinor2• 9 years ago

Not as explanatory. There would have been no difference from the ecological control then

benevol2• 9 years ago

On a related note, educate yourself fully about LSD. Then make your fully educated decision on whether to go ahead or not.

Kenji• 9 years ago

One is never fully educated until after the fact ;)

klibertp• 9 years ago

That might have been the point.

metaphorm• 9 years ago

related to your related note (which should have been less coy, and perhaps more informative):

Those interested might be well advised to read their history and learn about the work that Stan Grof and Walter Pahnke were doing before the drug war crackdown.

coffeemug• 9 years ago

That doesn't surprise me. Anecdotally, everyone I know who is on a "self-discovery" quest never seems to discover anything or actually get happier. They tend to stay miserable and keep looking indefinitely. The people I know who do improve tend to stop looking and start doing (exercise, learning new things, etc.).

dwringer• 9 years ago

I like how you contradicted the main point of your second sentence in the third sentence.

andai• 9 years ago

I imagine by self-discovery OP meant "thinking about / deciding what to do", rather than actually doing things.

_yosefk• 9 years ago

It could be that people telling others about such quests seem to fail in those quests. Not sure most people seeking therapy for issues greatly bothering them are going to tell you.

SubiculumCode2• 9 years ago

Neither am I. Ruminating on how we are deficient is no path to happiness or balance. Exercise, eat right, volunteer to serve others who are down and out, learn something new, work toward a purpose or goal, and if necessary, get pharmaceutical help, because for some no lifestyle or conduct can help enough.

DanBC3• 9 years ago

The entire point of modern evidence based therapy is to help stop people ruminating on how they feel deficient.

Alex3917• 9 years ago

The people I know who do improve tend to stop looking and start doing (exercise, learning new things, etc.).

Ironically this probably isn't only because doing things brings happiness, but because more experience means more context, and more context means more understanding. The only way to gain a better understanding of your life is to have more types of experiences, sitting there and thinking about it within the framework of the experiences you've already had generally isn't that useful.

E.g. the best way to understand why a previous relationship didn't work out is to have more relationships.

rrradical• 9 years ago

I just went through a long period of self reflection that I found very helpful. It wasn't easy, but there wasn't really another option as I didn't have the energy to try new things. Now I am doing new things again and it is of course helpful, but I can't discount the benefit that reflection provided.

pekk2• 9 years ago

the best way to understand why a previous relationship didn't work out is to have more relationships.

This ignores all the people who are leaving a trail of destruction in their wake without much self-awareness or guilt.

accountface• 9 years ago

That's a whole lot of correlation without causation

dang• 9 years ago

That's true of nearly all conversation, which is what HN threads are for.

colordrops• 9 years ago

everyone I know who is on a "self-discovery" quest never seems to discover anything or actually get happier.

then

The people I know who do improve

Despite the contradiction here, it sounds like some people do find something on their quest, and that thing is to start taking real action.

Nomentatus4• 9 years ago

Now that you mention it, I do know someone who did succeed in their quest - they lost a ton of weight permanently, changed a lot as a result of a spiritual experience; but also became a bit of a velvet-gloved menace, incapable of questioning themselves anymore. Zen refers to this sort of state as being "drunk with enlightenment," and they don't mean it in a good way.

charlieflowers• 9 years ago

"velvet-gloved menace"

What does that mean? Sounds interesting.

imesh• 9 years ago

Anecdotally, everyone I know who is on a "self-discovery" quest never seems to discover anything or actually get happier.

Everyone I know who says shit like that publicly is like that. Most people don't share stuff like that unless they are assholes.

temp246810• 9 years ago

It's a shame that stuff like this makes it to the top of HN.

Not because the content itself is good or bad, but because it is precisely someone struggling with this stuff who has a high likelihood of walking away from the article with the wrong message.

I understand that we're all responsible for our decisions etc., but this is really out of our wheel house and hopefully the people in need of therapy consult with professionals before acting on anything that bubbles up here.

benevol2• 9 years ago

hopefully the people in need of therapy consult with professionals

If your health care system gives you the option, that is.

epmaybe• 9 years ago

What do you mean?

civilian4• 9 years ago

rolls eyes people have got to have a little agency, and we can't censor things like this just because we're worried about them taking it the wrong way.

You know what would help get more people who need help into therapy? If therapy clinics allowed you to schedule a first session without having to call them! If you're suffering from anxiety and depression, then the thought of some receptionist asking you why you want to schedule an appointment is pretty terrifying.

DrScump• 9 years ago

One doesn't have to go into detail when merely scheduling an appointment with a non-therapist. In fact, that would be the makings of a HIPPA nightmare.

wpietri• 9 years ago

People who are in need of help may not have much agency to spare. E.g., The notion of Spoon Theory comes from someone with lupus, but you'll often see people with mental illness discussing it online: https://butyoudontlooksick.com/articles/written-by-christine...

And I think there are things between censorship and featuring anything that sounds sensational. One of the primary criticisms of mainstream science journalism is that it will take one recent study and focus on it excessively, giving readers a false impression. The same concern on Wikipedia is known as "undue weight": https://en.wikipedia.org/wiki/Wikipedia:Neutral_point_of_vie...

I don't think HN is above criticism on this.

zellyn• 9 years ago

Can someone with more insight in this field tell me whether this is the same as claiming that people who have heart surgery tend to suffer more subsequent declines in cardiac health compared to those who never needed heart surgery?

Mizza• 9 years ago

It might be more apt to say something like those who opted for an elective colonic irrigation ended up with higher rates of impacted bowels.

cavanasm• 9 years ago

Is there a non-paywalled version of this? The abstract seems painfully vague to me, or is there some domain specific explanation for desirable vs undesirable personality traits? Are they literally saying that therapy makes whatever people are in therapy for worse?

DashRattlesnake• 9 years ago

Have you tried Sci-Hub?

https://en.wikipedia.org/wiki/Sci-Hub

taurath• 9 years ago

So say you successfully make a change to one or more personality traits - I'd expect self esteem to go down, stress to go up and all the negativity experienced to happen. Changing personality isn't like putting on prescription lenses, it's like changing from green to red glasses. Things can become harder for a long time after a perspective change - most studies I've seen on CBT for example show it's still good for longer term outcomes.

programminggeek• 9 years ago

Focusing inward on problems and negativity is a great way to increase the feelings of negativity and hopelessness.

Instead, ignoring the how and why of a crap situation and simply working to improve your situation will improve your outlook on it.

Do stuff to make life better and you will feel better as if by magic. Just ignore the problems until they manage to disappear on their own.

One step in front of the other.

1 > 0.

Nomentatus4• 9 years ago

I do believe there's research on PTSD showing this, if you could find it you might reverse being voted down.

But there's evidence in favor of the opposite of the action you propose - people who see their problems and reversals as external and don't bother too much about them are much less prone to depression, according to the data. That doesn't mean they are successful or nice, of course.

DanBC3• 9 years ago

Focusing inward on problems and negativity is a great way to increase the feelings of negativity and hopelessness.

Repeating an earlier comment: the entire point of modern evidence based therapies is to help people avoid focusing inward on problems and negativity.

pekk2• 9 years ago

People with real problems like major clinical depression, severe anxiety that prevents them from leaving the house, schizophrenia, etc. aren't going to be suddenly cured now that you have told them "1 > 0" and all they have to do is put "one step in front of the other."

"Just ignore the problems" doesn't work for people who have problems which are, you know, actually serious.

rrggrr• 9 years ago

People alone with their negative thoughts do real damage to themselves and others. Therapy is the only and/or and appropriate resource for many of those people. Negative attributes from therapy? Without a doubt it says more about the modalities, and even the therapists than the patients.

drzaiusapelord• 9 years ago

Not to mention, from my own perspective as a therapy goer, a lot of personal and mental problems stem from a certain lack of social skills or immaturity, as well as working through trauma or biological mental illness (I have all three). Yes, you might come back from therapy a lot more assertive and "mean" than you were before, but its important to note you were maddeningly depressive and a zombie-like 'yes man/woman' before.

This reminds me a bit of the movie Awakenings, where one of the patients who came out of his coma was upsetting his mother. His mother was so used to him being this passive and lovable manchild that she couldn't handle him when he became assertive, spoke back to her, and wanted to spend time with young ladies and not with his mother. She never saw him go through a proper teenage rebellion stage and he wanted to live life immediately and really had no time for mother anymore because he just wanted to pursue his crush. To his mother, the therapy was a failure because she was no longer happy with him.

I also think there's an element of becoming jaded as one gets older, generally. The more experience you have with people, life, etc the more you realize we really are not good creatures and a lot of the wonderful optimism we've been taught be in a spiritual, social, or familial environment are often wrong, if not entirely false and people are just simply predictable animals fighting for resources. Therapy and other methods of self-discovery often lead to these self-discoveries and can really lead to a certain level of 'depressive realism.'

I read somewhere the happiest people are the ultra-religious and cult members. Everything is explained and everything is simple to them as a singular and unquestionable authority gives them all the answers. Therapy in the western tradition is pretty much the opposite of that. I guess you have to ask yourself if you want to be delusional and happy or realistic and perhaps have a good chance at being content with life and with occasional happiness and accepting of negative situations when they come.

I suspect most people's idea of a mentally healthy person don't fit in with what its actually like to be mentally healthy. Its not all smiles and laughter. Its also toughness and resiliency and the ability to say 'no' to you. If your friend came back from therapy like this, you'd think it was a failure, but I suspect he feels much more validated in life and much more autonomous.

civilian4• 9 years ago

You're giving an emotional argument against a group of statisticians. You might be right, but in the long run you're gonna have a bad time.

What if your "common sense" is wrong? What if it has been doing harm? You should embrace the statistical rigor going into therapy.

And also, "appropriate resource" is something that society can and should change. We ought to be able to hit any depressed person with a shot of ketamine, but it's still restricted and has the negative label of being a "Drug" and a "horse tranquilizer", despite it's effective history of use in serious surgery and it's current use in combat medicine in Afghanistan.

Shank• 9 years ago

It's worth noting that in the article, they too express some surprise at their results:

The most pressing issue that emerges is why these results run counter to the hundreds of more controlled, clinical intervention studies, which largely show positive effects of therapy not only on measures of distress and well-being, but also personality traits.

In addition, the discussion section states:

Thus, whereas individuals reported seeing a therapist in our observational research, they may not have seen them long enough to induce positive change. Further, it could be that some people started therapy because of a traumatic life event and actually declined at a less rapid rate than if they had not sought therapy.

As always, I think the answer is to wait and see. While they've noticed a correlation in two studies, it isn't that they've contradicted all of the prior evidence about therapy. Still, a neat read though.

civilian4• 9 years ago

PDF download link: http://dx.doi.org.sci-hub.cc/10.1016/j.jrp.2017.02.002

If you're new to scientific papers, the heuristic to use is: Read the Abstract, Introduction, and the Discussion/Conclusion. Methods & Results are boring and numbery, and you can dive into those later.

I highly recommend reading the whole General Discussion section. It's four pages. The main idea is that:

- There are previous well-controlled studies that show the benefits of therapy, but

- When we are simply observing a cohort of people, the people who have some form of therapy experience a decline in positive indicators and a rise in negative indicators. (Indicators like self-esteem, depression, etc)

This might be because:

1. The therapy did help, relatively, but because of the strong force from a patient's trauma, they were still generally doing poorly. But it could have been worse.

2. Because of the broad definition of "therapy experience" and the limited data in the survey, maybe this is mostly capturing people who only received a few sessions, and didn't continue long enough to receive the benefits, or in the case of the US cohort, only received drugs.

3. Maybe everyday therapists are kinda shitty? The therapists selected for controlled studies are always up to date with modern techniques. The paper said it more eloquently:

The third explanation concerns therapists who deliver therapy. Again, in a controlled intervention, treatment integrity is often one of the highest priorities of the research protocol. In contrast, implementation of empirically supported therapy in real-world settings may not happen with as much structure or rigor.

I think these are all good hypotheses, but the 3rd explanation is pretty scandalous.

kolinko• 9 years ago

Many therapists I met don't grasp psychiatry, and if a patient with a psychiatric problems comes to them, they will not be equipped to recognise the underlying issue.

Hence, even with the best therapist, the patient may be fighting an uphill battle.

Also, many patients are hard to convince that medication may be helpful, so again - uphill battle.

Finally, for some issues we know that they have a strong genetic component (Anorexia?), but there are no good medications for it yet.

I imagine that controlled studies correct for underlying psychiatric symptoms, but in real practice this is often omitted. Kind of like the point #3 you mentioned.

From personal experience: I had some amazing therapists over the years. Really good, helped me with all the issues and traumas I had in my life. But until I got diagnosed with ADHD and received proper medication, my life was indeed getting worse and worse.

The therapists helped me to get water out of a ship, but it was a psychiatrist who helped me find out the hole and patch it up.

AnotherHustler• 9 years ago

Additionally, the study does not differentiate between therapy types received - treatment modalities vary in efficacy depending on person and context. For example, 20 years ago it was known within psychology that "Cognitive Therapy" had about a 50/50 success rate. However, if you try to apply cognitive therapy to someone diagnosed with borderline personality disorder - it's not likely to work ever - and might actually make things worse (Dialectic Behavioural Therapy is probably the gold standard for this).

As you travel down the road towards being a psych. professional - you tend to subscribe a school of thought about behavior and personality, and there are a few to choose from (e.g. people are generally self-directed and will solve their own problems given the opportunity, or behavioural problems have their roots in learning - so training is required) - and depending on your opinion you'll eventually subscribe to a treatment modality that resonates with what you believe (the extreme version of this is abandoning psychology & switching to medicine / psychiatry because you believe behavior is simply a neurochemical process).

Serious personality disorders are very difficult to treat, which brings me to my next point. The Big-Five factor model used to determine change over time does not factor diagnosis, so we don't really get a picture of what the cohort looks like. We know nothing about patient history or reason for seeking therapy (i.e. have you been evaluated admitted to a psychiatric ward in the past? have you suffered from substance abuse problems?). And finally, the big question that would be useful is "what problems caused you to seek therapy?" Depression vs. hearing voices in one's head vs. got divorced because I like to drink are all very different issues.

I would like to have seen at least three more measures: reason for treatment, length of treatment and therapy modality used.

However, I will say that stating that "new research proves that therapy doesn't work" will get you a click or two ;-)

kazinator• 9 years ago

Scratching scabs positively correlates with increased bleeding and healing time.

KKKKkkkk1• 9 years ago

A few years back, there was a prestigious psychology journal that published a paper about extrasensory perception. I'm wondering whether the extrasensory-psychology journals are distinct from the clinical-psychology journals, or do they have the same levels of scientific rigor?

laughfactory• 9 years ago

I've previously experienced two kinds of therapy: one which emphasized the "what do you feel, why do you feel like that, what or who caused you to feel this way", and one which completely disregarded the past, who was to blame, etc. and which instead focused on what actions I was presently taking, and what positive outcomes resulted from my actions. Guess which method worked.

Unfortunately, I think a lot of the therapy out there is the first type, which for me, and most (I suspect), just makes the negative spiral worse. You spend MORE time thinking about what's wrong with you then you did before (if that were possible).

The second approach was life changing for me. I learned to let go of the past, and focus on what I'm doing which works (which, surprise surprise, leads to more of such behavior). And interestingly enough, the therapy was relatively short term: something like three months, once a week. And that was almost ten years, marriage, and three kids ago--and I'm still practicing to good effect what I learned in that brief time.

So my advice to anyone who will listen who's in therapy or interested in it is this: seek out a counselor or therapist who focuses on short term therapy which focuses on present action and positive (desirable to you) outcomes. Every other approach, IMHO, is a waste of time and money...And may make you more worse off in the end. These people can be hard to find, but they're worth their weight in gold.

Therapy Experience Associated with Negative Changes in Personality

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