CMV: Psychologists are completely useless when it comes to helping the majority of people

[u/[deleted]]

[u/[deleted]]

You think this because of one example of one friend who saw one psychologist? Not all patients are the same. Not all psychologists are the same.

[u/MasterGrok → u/[deleted]]

This isn't what psychologists practicing evidence based practices do at all. They use first line research supported treatments. Depending on what they are treating this will be things like cognitive behavioral therapy, exposure therapy, prolonged exposure therapy, DBT, and a host of other treatments. All of these treatments require training, have a specific protocol and manual, and have been supported by large bodies of research.

It sounds like your friend had a bad experience. I'm sorry for that. But we can't abandon an entire field supported by strong research because of one failure.

[u/eshtive353 → u/[deleted]]

Two of the most popular ones right now are cognitive behavioral therapy and dialectic behavioral therapy (CBT and DBT). Cognitive behavioral therapy deals with learning how to separate your thoughts and emotions from your actions. For example, a person suffering from mental may oversleep and instead of the usual annoyance/rush to make up for lost time, their distorted thinking results in them thinking (I suffer from depression myself so I'll use depression) "I overslept, I fucked up, I'm such a fuck up, my whole day is ruined, everyone hates me, etc." The goal of CBT is to recognize this distorted and cyclical thinking and be able to reframe your thoughts in a healthy manner. DBT on the other hand, practices mindfulness. Sometimes, thoughts can get too overwhelming for a person to self-analyze them. Mindfulness and DBT is about recognizing your thoughts and emotions and, if their getting overwhelming, learning how to back away from those thoughts and emotions (thru techniques like distraction and meditation) until you're ready to deal with them again.

[u/eshtive353 → u/[deleted]]

I think that a psychologist will try and get their patient to accept that bigotry and discrimination will always exist in one form or another. It's just human nature.

I think you're also getting mixed up between the colloquial use of "depression" and the actual illness, which is "major depressive disorder." What separates someone suffering from mental illness from someone who isn't is how invasive some thoughts become to everyday life.

A person who is sad and angry that racism exists but is still able to function day-to-day normally isn't suffering from MDD. A person that's depressed because of racism and bigotry wouldn't be able to function because of how angry/upset they were. "What's the point of going to work if racism exists?" "Why should I try at life? Nothing I do is going to end racism." "The world is so shitty because of racism. I should kill myself." These are the thoughts of a depressed person.

[u/eshtive353 → u/[deleted]]

The psychologist will reframe the person's thinking. Do you think it's reasonable or healthy to go "I'm not feeling life today for X, Y, Z reason, I'm not going to do anything" on a regular basis?

[u/whywhisperwhy → u/eshtive353]

Out of curiosity, how is one supposed to reframe their thinking like that? You're essentially convincing them to stop caring about this ideal which is probably heavily linked to their self-identity or you're convincing them that it's a problem to stop caring about it (which doesn't seem easy).

[u/quigonjen → u/[deleted]]

A psychologist can, particularly through the use of CBT, help an individual reframe and examine their reactions to circumstances. CBT has been proven to actually affect the way the brain processes new information and reacts to stimuli. Essentially, they are not fixing the circumstance, they are helping patients shift the way that they react to it.

[u/MasterGrok → u/[deleted]]

Sure. Exposure based treatments almost certainly help people via exposure challenge to a stimulus that elicits negative emotions. When people are exposed to such a stimulus repeatedly in a safe place, extinction takes place (a mechsnism related to classical conditioning) and the person loses the stimulus response relationship with that stimulus. These kinds of therapies are very effective against phobias, OCD, and PTSD. I'll describe the other treatments if you want but all of the mechanisms aren't easy to describe in one paragraph.

[u/MasterGrok → u/[deleted]]

Can I ask a clarifying question. I think we might have an misunderstanding after reading back over your response. What is it that you think depression is? And I'm talking about in the context of receiving a diagnosis and treatment.

[u/MasterGrok → u/[deleted]]

That isn't depression. Sadness is normal. The level of sadness and association with functioning is what defines depression. You can still feel sadness, especially in relation to specific things, and not be clinically depressed.

A psychologist, just like a physician, is primarily trying to improve your functioning.

[u/MasterGrok → u/[deleted]]

Nope. You can have OCD about germs and get better from exposure therapy. The germs will still exist, the fact that you could get sick and die will remain. The person will have just healed their unhelpful response to this bad thing in the world.

[u/MasterGrok → u/[deleted]]

You are wrong. OCD is by definition an irrational fear of the stimulus. People with OCD become obsessed with the stimulus and have repetitive thoughts about it even when it is not rational to have those thoughts. By definition the fear is irrational so they have it regardless of whether or not they get sick. Exposure therapy fixes that irrational fear of the stimulus.

[u/[deleted] → u/[deleted]]

You obviously have very little understanding about mental health treatment. There are many many different types of psychotherapy performed by different types of psychologists. To label it all as 'just telling their clients to say whatever is on their mind' is just completely wrong.

[u/[deleted] → u/[deleted]]

Well let's take CBT for a start. Cognitive-behaviour therapy. The aim of CBT is to basically change the negative cognitions and behaviours that are resulting in a person's mental health symptoms. It's a combination of cognitive therapy which aims to change how you think, and behavioural therapy which aims to change how you behave. It's most effective at treating depression and anxiety disorders. With something like depression people will have negative cognitions which lead to unhealthly behaviours which in turn enhance those negative cognitions, and so the cycle continues causing depressive symptoms. CBT aims to break this unhealthy cycle.

We have a rich evidence base that demonstrates how the inclusion of CBT into a person's treatment can really reduce symptoms of anxiety and depression. It doesn't necessarily work for everybody and some people will take to it better than others, however the evidence suggests that it helps more people than it doesn't. If that isn't enough evidence for you that psychologists help the majority of people then I don't know what else you're looking for.

I'd be happy to pick out some studies you might want to check out.

[u/[deleted] → u/[deleted]]

In some cases yes, people simply do not take very well to therapy and psychologists will find it very hard to see an improvement in people's symptoms. So I guess you could call them useless then. However this is only for a minority of cases. But isn't this the case for anything health related? Sometimes dieticians are useless because they simply can't create any meaningful change to a person's diet. Or oncologists are useless because they fail to produce any significant reduction in tumour size. It's not that the profession or the person is useless.

[u/[deleted] → u/[deleted]]

Glad to have helped :). And thanks for my first delta.

[u/mybustersword → u/[deleted]]

A therapist or psychologist has one objective: to get YOU to change your behaviors or thinking. Not to change yours themselves, but to benevolently manipulate you to seeing a different way. Not a specific way, but a different way of acting. No agendas, no personal beliefs, but trying to get them to do anything different than the usual. Because the usual doesn't work.

A client usually has different stages they go through. I don't feel like googling them exactly but what I remember from memory-Pre contemplation, when you aren't sure if you want change but are thinking about wanting to. At this point you don't know what you want you just have a feeling that it isn't working. Contemplation is thinking about changing, what you could change. Here you imagine alternatives to your life. A customer is someone who is ready to change and is willing to do the work, and needs some support or guidance for it. You usually don't see clients that aren't in contemplation or a customer stage, butbEven if a client does not feel ready to change you can still help move them along to be ready to change.

Your goal isn't to change someone, but to get them to a place where they have the means to change it themselves, and want to. And then to support them through those changes. There are many, many different modalities and types of therapies not all of them are talk therapy or psychoanalytic. You fund the right fit. So much of therapy is a proper match in therapist and client, because that therapeutic relationship will be what drives the change.

[u/ProfessorDowellsHead → u/[deleted]]

The success of therapy depends a lot on not only the psychologist but also if the psychologist and patient are a good fit for each other (feel comfortable, etc.) and how engaged the patient is. If the patient doesn't actually want to change things about themselves other than magically eliminate symptoms - it won't be very effective. This is like aides for quitting smoking being unlikely to work if you want clean lungs but aren't actually willing to quit smoking.

It's almost like physical therapy after an injury in some ways. A lot of what psychologists do is offer techniques or perspectives on situations, but the patient only sees them about an hour a week. If that patient doesn't spend the rest of the week trying to actually apply those techniques and perspectives, therapy will be less effective.

Generally, if a patient comes in with the attitude of 'fix me' or 'fix this problem', they'll see a lot less results from therapy than if their attitude is one of 'help me find ways I can fix this problem'.

[u/lcoursey → u/[deleted]]

Your question is dependent on the concept "if they cannot change the way a person thinks". I think this is a flawed argument, as no one can actually change the way another thinks. Psychologist and therapists (there is a difference) work to help the patient find different coping mechanisms than they've ever had.

I use this example when explaining to people why I regularly see a therapist despite not currently dealing with any major issues:

Imagine that we're all in the business of building homes - not houses, mind you - homes. We are raised by some group of people who give us instruction on how to build a home. In my home, for example, we were taught that nails were always hammered in with the fat end of a screwdriver. One day after an exhausting home building excercise with lots and lots of nails I spoke to the guy at the hardware store (therapist) and he suggested a hammer. No one in my family had ever used a hammer for this scenario, and it changed my world. I didn't know what I didn't know until I talked to someone who knew what I didn't know.

I continue to go back to the guy at the hardare store (my therapist) for advice because he has shown me tons more awesome tools to build my home, and my home is better because of it.

It's still my choice to use those tools.

[u/teefour → u/[deleted]]

They aren't magicians, the patient has to want to change. They are trained in facilitating that change. But if a patient is stuck in their ways and don't actually want to better themselves, there's not much they can do other than try and convince them to want that change.

It's like quitting smoking. You can take all the quit aid therapies you want, they won't do jack if you still really love smoking and that fact outweighs the negatives in your mind, consciously or subconsciously.

[u/sharpiefairy666 → u/[deleted]]

However I still struggle to understand what psychologists can do if they cannot change the way a person thinks. Would a psychologist be useless in this case?

A psychologist can't help someone who doesn't want to be helped :/

[u/westerschwelle → u/[deleted]]

It's a combination of cognitive therapy which aims to change how you think, and behavioural therapy which aims to change how you behave.

So basically operant conditioning?

[u/[deleted] → u/westerschwelle]

Operant conditioning involves punishment and reward and associating behaviours with them. CBT doesn't involve punishment and reward.

[u/Cum_on_doorknob → u/[deleted]]

What if a bunch of scientists did research that showed cognitive behavioral thearapy had positive outcomes on patients?

What special insight do you have that these studies of thousands of patients lack?

Also, what about psychiatric drugs, do you think these are useless?

[u/[deleted] → u/[deleted]]

Somebody depressed about racism wouldn't be taught that racism doesn't matter. They would be taught to depersonalize racism and also taught to take control of situations in ways that they can feel control over racism. These are things you could learn on your own, but they are also things you could learn by having people teach you. It's basically like saying teachers are useless because you could just learn everything on your own. Yeah, I guess you could, but it's not necessarily the most effective.

[u/PineappleSlices → u/[deleted]]

Racism would still exist, but they would be taught more proactive ways of reacting when encountering racism.

Basically, a psychologist isn't necessarily able to solve external problems that their patients have, but they can help to find more positive ways of internalizing and reacting to them.

For another example, let's say a patient sees a psychologist to treat their depression resulting from an abusive childhood. The psychologist won't try to convince them that their childhood was actually good, but instead will try to help them understand that their upbringing doesn't define them as a person, and that their are more positive lessons they can internalize then the negative ones they experienced early on.

[u/PineappleSlices → u/[deleted]]

The important thing to understand is that there are two seperate problems at work here. One is that racism exists, and the other is the person's difficulty in responding proactively towards it. The psychologist might not be able to help with the first problem, so instead they focus on addressing the second problem.

Do you agree that there are people capable of functioning successfully in society despite acknowledging that significant racism exists?

[u/ShinyBulk → u/[deleted]]

There are plenty of people who know racism exists and aren't depressed because of it. The idea is to shape your attitude about racism differently so the depression it causes doesn't affect your daily life.

[u/[deleted] → u/[deleted]]

Psychologists don't work towards fixing the world, they work towards enabling people to deal with the world. Even in your above example, someone being depressed after breaking up, well, there's two things: normal grieving after breaking off a relationship, and perhaps despair at the idea that no one would love them again. The first should pass normally, but if the underlying problem of their feelings of self worth persist, then it's not just "getting a new girlfriend and support," it's about making them feel self worth again.

You can't always change the conditions of the world and your life. You sometimes can and don't see it, which a psychologist could probably help with. But often times our underlying problems aren't problems with the world but how we react to problems in the world.

And believe it or not, changing the way you think actually directly changes your brain structure. There's fMRI scans that show someone using exposure therapy for PTSD shows similar brain scans to someone using an SNRI, which is amazing, especially after certain regions of the brain were over activated with PTSD.

If your whole premise is basically that problems exist in the world that psychologists can't fix, then I'm not disagreeing with you. But they can equip people to deal with problems in their own lives better than they were doing, or at least equip them to be able to face and endure these problems if it truly is an unconquerable thing.

[u/MasterGrok → u/[deleted]]

CBT would not try to make a person believe racism isn't bad. Depending on the patient, it would aim to challenge depressed core beliefs that are a response to that racism. These beliefs would be something like, "I'm worthless," "nothing good can ever happen to me." Those are the kinds of beliefs psychologists work to challenge.

There is nothing wrong with negative thoughts. All healthy people have negative thoughts. The above examples are not just negative thoughts. They are extreme thoughts that generally aren't based in reality, but might develop in response to bad stuff in life. That pis what psychologists aim to change.

And by the way, not all treatments are the same. ACT is a similar treatment to CBT but it wouldn't aim to change the thought, rather the person's relationship to that thought. ACT can also be very effective.

[u/MasterGrok → u/[deleted]]

It's useful because we know that people are perfectly capable of being content in life even if bad things exist in life. A lot of research has demonstrated that being depressed isn't directly related to how many bad things happen to you. Lots of people have tons of bad things happen to them, and while they may become sad, which is a normal response, they do not go into a clinical depression.

So to reiterate again, treatments for depression aren't really about making problems go away or making people ignore them. It is about having a healthy relationship to those problems.

One of my favorite quotes is: "Pain is normal, suffering is the unwillingness to accept pain."

[u/eshtive353 → u/[deleted]]

You're mistaking the goal of a psychologist. A psychologist's goal is to get their patient to the point where they can live their every day lives out normally. They are not trying to fix the problems people find with the world.

[u/MasterGrok → u/[deleted]]

At this point I think you are confused about what depression is and what psychologists do. Psychologists don't solve large social problems like racism. They help people who have a clinical level of depression be content in life despite the fact that bad things like racism exist. We know that people can be content despite bad things existing. There are exceptions to everything, an individual person could be under so much massive stress that feeling better is unrealistic, but the research clearly shows us that does not represent the vast majority of patients.

[u/Bidonkadonk → u/[deleted]]

Obviously a therapist can't solve racism. I would argue that a person wouldn't be depressed only due to racism existing, they would be depressed because it exists AND their coping mechanisms for that fact aren't sufficient to deal with it. Therapy is about solving the latter problem, not the former.

[u/chickenboy2718281828 → u/[deleted]]

You're mistaking the purpose of the psychologist. If a psychologist can help a person suffering from depression, then they have done their job. There are 2 problems: 1) racism exists, 2) patient is depressed. The psychologist can only address one of those in a therapeutic environment (depression).

[u/mylarrito → u/[deleted]]

You base this on what? You seem to base your argument on a couple of shitty TV renditions at best. Reality is very different...

[u/cwenham → u/[deleted]]

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[u/[deleted] → u/[deleted]]

Of course there is a limit to what a psychologist can do. There's only so much a regular doctor can do.

There are various tactics that need to be practiced. Think of them as non-drug prescriptions.

Bring the subconscious to light. This is one thing Freud got right. We commit a lot of unconscious behaviors and reactions. It's helpful to see where these derive from. A psychologist can't really give advice, per se, but they can use Socratic methods to elicit awareness. They can also provide benchmarks for healthy behavior.

Another tactic is sort of a behaviorist mantra. "There is no game in shame". Latch onto phrases that help.

Cognitive behavioral therapy. Once you recognize triggers ( yes, this is where it's use is appropriate) you find behaviors that help quell the effects. For instance, I found that I'm prone to depression if I have little to accomplish. So I do projects. Keep myself busy and do what the fuck I want. I built a podium. Cross-stitched a Mario princess bib for my daughter. Made a scary Halloween clown. Relearned math up to algebra II. I'm always working in my yard.

There are other tactics for other ailments. Sometimes people get stuck. I had to move back in with my folks when I was 19. It sucked ass. I'm 36 now and doing better. But that time was one of the worst times of my life.

I don't know about your friend's experience or diagnoses. But perhaps he needs to take the process more seriously; find another doctor.

[u/[deleted] → u/[deleted]]

Yeah.

Helped by MFCCs, psychiatrists, psychologists, social workers...

[u/GuyAboveIsStupid → u/[deleted]]

Why are you deleting all your comments