Therapy experience is associated with negative changes in personality (2017)

https://www.sciencedirect.com/science/article/pii/S0092656616302410?via%3Dihub

by monort • 8 years ago

87 43 8 years ago

the study's conclusion, if i'm reading it right, is that therapy is associated with a tendency in people toward fewer good traits and more bad traits. an interesting result given how often therapy is recommended as helpful.

study seems to have used some kind of matched pair design. maybe there's something to this...

tlb• 8 years ago

They don't make a claim for causation. As they shouldn't.

outlace• 8 years ago

“this matched sample is used to estimate the causal effect of therapy experience”

s-shellfish2• 8 years ago

Therapy involves lots of talking while life happens. It isn't magic. Sometimes life just sucks for people. Sometimes it's hard on people. Good traits and bad traits put a fuck ton of a huge burden on individuals. There's the whole world. The world affects all people, regardless of whether you know how to see how it does.

ChrisSD• 8 years ago

Published in June 2017 and has no citations? Huh.

sdf43543t345• 8 years ago

These freaking knowledge paywalls are awful, try scihub: https://sci-hub.tw/https://doi.org/10.1016/j.jrp.2017.02.002

forgetcolor• 8 years ago

Interesting results (thanks for the SciHub link), but also a call for more research. Not enough info yet to rule out a likely explanation: that those who seek therapy were already in a negative situation, and thus the therapy is a symptom of a problem rather than the cause of one. They discuss additional interesting angles about it near the end, re therapists who don't follow standard protocols, patients who don't stay with therapy, etc.

gfs782• 8 years ago

Problem is not with therapy in itself but with the skill and-or decency of the therapist. Just as happens with mechanics, programmers, etc.

The unskilled will make a mess of what they are given out of incompetence.

The dishonest will make a mess of what they are given out of greed and malice.

Sadly, in this case, the one suffering the consequences is not a car or some code but a person.

white-flame• 8 years ago

As this appears to be about measuring statistical association, and not just singling out individual failure cases, are you implying that the entire industry is generally filled with unskilled and dishonest people?

Edit: It was an honest question, and it does appear to be considered an untrustworthy profession as a whole here. I was just asking clarification if that was the intention of the parent poster.

s-shellfish2• 8 years ago

There's an information imbalance. A lot of people have access to lots of stuff that can tell them how to live their life better. They have access to information about psychology, about how their brain works. They have access to information that in endless varieties of ways, can 'hack' their brain, change them.

1. This doesn't make people happy. Constantly trying to fix yourself is like running past the goal post as soon as you get there.

2. Life just sucks sometimes, and therapy doesn't always make it better. You can't force a therapist to actually have compassion and empathy for someone if they don't. This may be complicated. Therapists and stuff may have their own issues, like the fact that they have to deal with a world where everyone has access to almost the same information they do. How can they help? How can they deal with a dynamic where a mentally ill person may even understand this, and have compassion for it? That has to be confusing.

The world is crazy and there are no rules. We want to believe there are rules when there is chaos, but there aren't. Sometimes you just have to trust people. That can be really scary if you don't know them, and it can also be really scary if you've been educated into a career where you are constantly on the lookout for people that could be ... dangerous.

Also culture. There's a fuck ton of stigma going around for mentally ill people lately. Just because we were more aware of it a couple of years ago doesn't mean it improved collectively. We've taken a massive step backwards culturally when we blame every horrible thing that happens in the world on mentally ill people. That's all in the cultural background noise, it changes things, affects the ways people see things, affects their fears. We are not omnipotent beings that know everything.

Some information that people with fucked up intentions intend on spreading for whatever intent - you gotta fight it. If you don't, it's going to hurt you in the long run. That's something I've learned through lots of confusion.

smt882• 8 years ago

Are you saying all industries have a normal curve of skill, with the middle of the curve being neutral/zero?

Zelphyr• 8 years ago

My experience tends to confirm this. I have had two personal therapists, one was of the "Why do _you_ think you feel that way?" ilk with some kind of counseling certification, and the other was an evidence-based practitioner with a PsyD. The former didn't help me at all and the latter changed my life.

My wife and I saw two couples therapists. One was, again, a guy with some kind of certificate that did things like literally pulling the Good Will Hunting "It's not your fault. It's not your fault." hand-on-knee line as well as outright verbally attacking my wife. The other was a PsyD who made more progress with us in three sessions than almost a year of sessions with the other.

The crux of it all, in my estimation, is that you get what you pay for. A PsyD having a doctorate can command hundreds per hour which puts them out of range for many people.

gfs782• 8 years ago

Yes.

mattnewport• 8 years ago

If you have a bacterial infection, a relatively incompetent doctor giving you an antibiotic is going to do you a lot more good than the world's best homeopathist. The question then is whether therapy is more like medicine or more like homeopathy. This study suggests it might actually be worse than homeopathy which at least doesn't appear to cause worse outcomes than doing nothing.

ianlevesque• 8 years ago

at least doesn't appear to cause worse outcomes than doing nothing

I wouldn’t be so sure https://arstechnica.com/science/2017/09/cdc-homeopathic-heal...

zentiggr• 8 years ago

Right... I'm going to pay Elsevier to read an article about anything.

smt882• 8 years ago

Can you explain your comment to those of us who aren't in publishing or academia?

bokumo• 8 years ago

Here is a web site dedicated to explaining why many academics are boycotting Elsevier: http://thecostofknowledge.com

lsiebert2• 8 years ago

This was longitudinal study where people who chose to go to therapy were compared to those who didn't chose to go, not a randomized experiment with a control group.

Here's a link that gets you a pdf, I recommend reading the general discussion.

https://scholar.google.com/scholar?q=Therapy%20experience%20...

tunesmith• 8 years ago

People who choose to go to therapy probably tend to generally feel more negative feelings (and express them) than people that don't. Is this study anything more than pointing out that obvious correlation? I don't see how they can demonstrate causation without randomizing with a control group.

msoad• 8 years ago

Yup, people who mix correlation with causation will end up dead.

woodandsteel2• 8 years ago

My understanding is that the study looked at change over time, so it's not as badly designed a study as a simple correlation, though it is still not ideal.

lsiebert2• 8 years ago

Well, I mean an obvious correlation isn't necessarily real or proven until you measure it, so this isn't nothing, but it's not what I think people saw when the read the title, which was evidence that therapy itself lead to worse outcomes.

api• 8 years ago

Also: did therapy cause these apparently increases in negative characteristics or unmask them? It's possible that after therapy people were less in denial about their actual feelings.

Overall it seems like a fairly shallow study, though it does raise questions.

entwife• 8 years ago

Common sense would say young adults with negative personality are more likely to start therapy. Logic says correlation does not equal causation. The authors argument about their renegade research/analysis, is not persuasive as to why correlation equals causation within the scope of their longitudinal analysis.

perl4ever2• 8 years ago

I agree that correlation does not equal causation, but I wonder if that, reframed, is actually a reason why therapy can be harmful. Therapy tends to treat negative thoughts as things caused by events and/or other thoughts, and this itself may be a pernicious way of mistaking correlation for causation. I think a fair amount has been written about how harmful therapy is when applied to people with serious mental illnesses, because it encourages people to dwell on negative thoughts and come up with spurious and unhelpful reasoning about causality. But if it doesn't work in the most severe circumstances, why should we remain committed to the belief that it works in less severe ones?

duopixel• 8 years ago

Let's think about personality traits in a depressed person:

Extraversion: "leave me alone"

Agreeableness: "the world is shit"

Conscientiousness: "my home is a mess"

Openness: "Why try something new if I know I'm not going to like it"

Conscientiousness: "my home is a mess"

People who go through these phases, or live in this reality, are more likely to have seeked therapy. The results could imply that, after all, it is not very effective, since it is observed that "Therapy experience is associated with negative changes in personality", but to make the analogy clear, you could say: "People with heart transplants see reduction of heart function".

extralego• 8 years ago

I have anecdotally experienced this, among other more measurable negative outcomes of therapy. My experience was in America, which as I understand has a similar psychology industry to most European countries, albeit the extra double dose of exceptionalism, rigidity, and economic depravity one would expect.

Misdiagnosis was the worst part of my experience, but not the beginning or the end. Diagnoses are naturally a double edged sword and some therapists avoid them altogether, but it seems a clear mistake to focus on this conflict.

Bureaucracy notwithstanding, a lot of the reason for diagnoses is that the suffering seek closure. I declare however that a lot of the reason for the mental health field is that the citizens of a suffering society seek closure. The therapist delivers that closure in the form of: “It’s you.” Whether this contributes something wholly productive to that person’s mental health is surely circumstantial. For me, it was a disaster.

I’m not comfortable making similarly broad assertions about therapy itself, but in my experience, it was just me opening up to someone who didn’t open up to me. Having a 3rd party to resolve disputes is not any new invention so couple therapy and similar should probably be considered separately. As for individual therapy, I have been inable to map the process by which what we call therapy today evolved from what was psychoanalysis. My fear is that it was painfully basic and painfully stupid. Can someone fill me in?

Some of my friends are in the mental health field and a couple of them are very open minded, willing to discuss these things. Our conversations led me to make a vow that I will never visit another mental health professional for as long as I live. Being no stranger to the history and other less contempory criticisms of psychology, the experience motivated me to learn more about the industry of psychology in America. I think the issues are strikingly congruent with contextual issues in the structures that empower it. In the US, this would be law enforcement, healthcare, academia, public education, the economy. In a sum, I concluded that capitalism is simply not as fit to address mental health problems as it is to create them.

chiefgeek2• 8 years ago

From my own experience, therapy was only the first step. It wasn't the solution. The further I went down the path (more than 10 years on my own, couples therapy for over a year with my ex-wife, and two separate one week intensive experiential retreats) the less helpful it was. After doing work with a Zen coach, meditating regularly and going on a ten day silent meditation retreat what became clear to me is that therapy tends to drag one's focus back to what happened in the past to explain the present. I think therapy has a place. I think it would be exceedingly difficult to create a valid study that proves what this piece claims.

petra2• 8 years ago

did you find the meditation more helpful?

chiefgeek2• 8 years ago

The meditation is very helpful. The 10 day vipassana course was very insightful. Even if I can just manage 30 minutes a day, I feel better, more calm.

knaik94• 8 years ago

In one study of treatment-as-usual for drug and alcohol disorders, the researchers found that most therapists failed to implement well-validated intervention techniques (Santa Ana et al., 2008), choosing instead to focus on assessing social functioning and asking open-ended questions, rather than changing relevant thoughts, feelings, or behaviors.

This is what stood out to me and seems similar to problems I hear regarding internal medicine. Doctors trust their intuition above results of novel studies. It takes time for their recommendations to catch up.

swsieber2• 8 years ago

Edit: The authors of the study don't imply causation, but it's tempting to infer it yourself. Thus, my comment.

OK. So this is a observation study, not an experiment. Only correlation can be inferred, not causation.

To make it clear why you can't, let me come up with a new, parallel study:

Track everybody who self reports being told they have a genetic disposition to cancer by a doctor. Divide them by those that decide to go a cancer treatment center vs those who don't. The study would probably show that cancer treatment centers are associated with shorter lifespans.

That makes sense, because you're not going to go to a cancer center treatment if you don't have cancer. But it doesn't mean that going to a cancer treatment centers are ineffective.

Self selection in a study means you can't infer causation. You can only infer correlation.

Note: I'm not actually weighing in on whether I think therapy is good or bad. I'm say the results of this study could happen either way.

Edit: I think you could reasonably infer that therapy isn't enough whenever it is used. But you can't tell if not going to therapy would have been better than going to therapy for those who did - so if there's an action item from this study, it's to improve therapy. But I don't think you can unequivocally say: this study shows therapy is bad.

windows_tips• 8 years ago

Is someone inferring causation? From the title, we can at least conclude that "therapy" did not "prevent" measured negative changes.

swsieber2• 8 years ago

Ah, this is prompted by a conversation I had with others. I'll add a general disclaimer.

drngdds• 8 years ago

"in naturalistic observational studies"

You shouldn't remove something so relevant from the title.

woodandsteel2• 8 years ago

This doesn't surprise me.

Let me start out by saying that although I am not a psychotherapist, I do have a masters in psychology, and two years graduate clinical training, plus experience in the field. I also have some experience helping conduct psychotherapy research studies.

Back in the 60, a well-known psychological researcher named Hans Eysenk published a claim that, based on an analysis of many psychotherapy outcome studies, psychotherapy does not work. This sparked a great debate.

I was puzzled by this claim, since it seemed clear to me that psychotherapy could be helpful. But then years later I read an article in the Handbook of Psychotherapy and Behavior Change, I think it was the 1979 edition.

It was written by Truax and Carkhuff, and it summarize a number of studies that looked at outcome by psychotherapist. What they found was that about 1/3 of psychotherapists were helpful with most of their clients, 1/3 had little impact, and 1/3 were on the whole harmful.

Based on a good deal of experience in the field, including a whole summer observing psychotherapists practicing group psychotherapy in a mental health clinic, this seemed to me about right.

I think the problem started with Freud. He was a brilliant man in many ways, but I think it is clear he was not very good at actually curing people of their personal problems. In the decades that followed, I think there was a pattern that developed where some training institutes, Freudian and non-Freudian, were run by therapists who are poor at the craft and so don't know how to teach it to others, and furthermore don't know how to select students who would be good therapists, while at other institutes the overall pattern was neutral or positive.

I have been out of the field for many decades, and had hoped things had improved. Alas, it seems that is not the case.

Therapy experience is associated with negative changes in personality (2017)

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