Psychotherapy including CBT and other counselling - benefits and harms

Dolphin

Dolphin

Senior Member (Voting Rights)
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Dolphin said:
Somebody drew my attention yesterday to this article from 2008. Doesn't discuss ME/CFS so not important but I found it of general interest
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Interesting indeed. I am tempted to say not so much a dark underbelly as the whole spectre of a pink elephant in the room.

As a result of psychotherapy one member of our family was led to believe that her parents were wicked and she never spoke fondly to them again until they died. That is real damage. Not just to the patient but to everyone around. I fear the author does not get the fact that the whole business is nosy parking based on less than the human charity that would be there otherwise.
 
Merged thread

How CBT Harmed Me: The Interview That the New York Times Erased
Alana Saltz, 2021

In August, I was contacted by a reporter writing an article for the New York Times on cognitive behavioral therapy (CBT) as a treatment for chronic pain. They had seen a Twitter thread I wrote that criticized CBT, calling out the harm it can do to chronically ill and disabled people like me, especially when it’s used to treat chronic pain and trauma.

I told the reporter that I would only participate if the article wasn’t going to perpetuate any ableist ideas or attitudes. I was aware that the New York Times has a history of publishing problematic content around chronic illness and disability. The reporter assured me that they would be respectful of the patient perspectives the article was including and that they wanted to get it right. So I agreed to do the interview, hoping my story might bring awareness to how harmful CBT can be as a treatment for chronic pain.

The day before the article was scheduled to be published, the reporter emailed me. They said the piece had been rewritten by their editors with all of the patient perspectives removed....

Full text at: https://disabilityvisibilityproject...the-interview-that-the-new-york-times-erased/
 
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Ariel said:
I was upset by this story. I hope the NYT changes course generally in the stuff it is publishing about CBT and chronic pain. Who is behind this push, does anyone know?
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I have done much less therapy than the writer, but her decription of her experiences with CBT being harmful was very much like mine.
I imagine the article was commissioned at the behest of advertisers such as health and disability insurance companies and therapy companies.
 
the article said:
More and more organizations are realizing the harm that modalities like CBT and graded exercise are doing, removing them from recommendations and guidelines. After reading the entire chronic pain series released on November 9th, it’s apparent to me that their goal was to perpetuate outdated, victim-blaming treatment models like CBT, graded exercise, and toxic positivity to discourage the use of pain medication, once again intentionally neglecting to include relevant research, activism, and disabled people’s lived experiences.
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That link takes you through to a Guardian article about the NICE ME/CFS Guideline (at the time, the draft version). :)
 
The NYTimes Pain Report, a well mind category (is that a sloshy wellness category they have in which they tell you how to wipe the GOOP off your bum?) and this is a series of mish-mash articles.

Yes, the CBT for chronic pain does want you to learn to shove pain aside by using your cortex to tell your emotional brain that the pain isn't real, important, worth listening to. And Beth Darnall, psych at Stanford is a leader with this, although she posits that patients can still use pain meds. Oh really? First I've heard of it. They want you off pain meds, a primary goal. I was in a lot of pain yesterday when I read the article and there is no way my cortex could get through to the pain gods and tell them to stop it.

Other dumb articles are back to John Sarno for mild cases of lower back pain which can be influenced by emotions (yes, i do think this is real, as I have experienced my stress if left unchecked provoke some lower back pain and vice versa). But a big deal? No.

The only article (6 or 7?) that I got anything out of was the one about the glial involvement in chronic pain. Something to watch.

This newspaper is not good for depth and reality.
 
shak8 said:
And Beth Darnall, psych at Stanford is a leader with this, although she posits that patients can still use pain meds.
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Beth Darnell is an interesting one. She actually does advocate NOT tapering pain patients off of opioids. In 2017 when my state of Oregon was wanting to pass a chronic pain guideline similar to that in the UK (limited meds--especially no opioids, but plenty of acupuncture and CBT!), Darnell actually flew up here on her own dime to testify at the hearing against this policy and in favor of patients being allowed to continue their opioids (I attended this meeting via webinar). She's also been working at re-evaluating the whole "pain catastrophizing" questionnaire. Though I get the distinct impression it's to make it less offensive to patients, not because she thinks the concept itself is problematic.

And yet she's also a big part of the problem with the whole pain-as-somatization idea. As a psychologist, she strikes me as a good example of "if all you've got is a hammer, everything looks like a nail."
 
Mollon really seems to be having an internal struggle. He seems to love Freud and the idea of psychoanalysis but is acknowledging, with the help of some great quotes, that psychoanalysis has considerable risks and problems.

Despite my initial impression (edit - he has a couple of technical issues), I found much in this that was relevant and/or interesting:


First slide: 'Research indicates psychotherapy is often not very effective in alleviating people's problems and can sometimes leave people in a worse state.
but : 'The original and simple mode of therapy developed by Freud has become perverted in a variety of ways'

Bad experiences
'An NHS patient with severe regional pain syndrome (which is a terrible degenerative condition triggered by an injury) will soon be better if she has CBT. Absurd.'

'A patient is told that CBT will cure her anxiety - when it does not, she experiences even more panic.'

'A patient is referred for psychotherapy because of 'unexplained medical symptoms' - that catch-all phrase that is commonly used, and it's usually used with an implication that the person making that diagnosis thinks the problems are somehow of a psychological nature. But in reality that person has a serious disease, such as Lyme disease or Ehlers-Danlos Syndrome, hypermobility, both of which can give rise to a whole range, multiple physical or psychological issues.'

The case of Osheroff 10 mins
(somewhat surprisingly, the quote is from a book by E. Shorter. Oddly, because the case seems to favour medical intervention over talking therapy and Shorter has been a strong advocate for psychosomatic medicine.)
A doctor experiencing psychosis spent 7 months undergoing talk therapy, during which he lost his practice and his marriage, and was subsequently cured in a second institution with psychotropic medicine. He sued the first institution.

Dangers of emotional arousal 13 mins
'Interventions that risk increasing a person's feeling of being stigmatised or in which they are blamed for not meeting intervention targets, have been held to increase helplessness and self-blame, and so undermine a sense of self-efficacy.' There's an academic paper referenced for that quote, which might come in useful.

Hazards of CBT 14.45 mins
'CBT shifts responsibility onto the individual for engagement and conduct of the techniques. A recipient of this may feel guilty if the treatment does not result in the expected improvements, without realising that there are many other factors that may affect response.'

Dangers of psychodynamic therapy. 16.00 mins
'A potential consequence of externalising attributions of current difficulties to the behaviour of others (particularly parents) is estrangement and passive adoption of the victim role.' (I think this is a real danger where people are told that their ME/CFS symptoms are a result of childhood trauma.)

ADHD 21.30
'ADHD as a model of avoiding reality'. Mollon's description of ADHD ('Unrestrained narcissism' and 'pursuit of pleasure') struck me as very judgemental.

Freud - and outline of psychoanalysis 24.00
I thought the next slide on Freud's views of what the psychonanalyst should be doing was actually a better example of narcissism - the assumption that the psychoanalyst knew best. It's quite a freudian juxtaposition, I thought. Freud is quoted as 'Our knowledge is to make up for his ignorance and to give back his ego mastery over the lost provinces of his mental life. This pact constitutes the psychoanalytic situation '. Mollon approves, saying it is very good and sensible.

(but) Psychotherapy is sometimes not very effective 25.00
Quotes 'The Great Psychotherapy Debate' Bruce Wampold
Some percentages given on outcomes e.g. 15-24% of adolescents leave therapy in a worse state than when they started.

'Much hyped NHS IAPT Programme' (Parry et al) Only 6% of people referred to the programme recovered. This figure isn't publicised.'
(Could be worth tracking that paper down if we don't have it already.)

The most consistent finding in psychotherapy research is that there is very little difference between different sorts of therapies. The difference is between therapists.

Psychotherapists' Blind spot 28.00
90% of psychotherapists think that their outcomes are better than average.
Lambert did some research asking therapists to identify patients deteriorating under psychotherapy and likely to leave therapy worse off, and concluded 'psychodynamic therapists are usually over-confident in their clinical judgement'. Only one of 40 therapists, a trainee, was able to identify one such person, even though the researchers identified 40 such people out of 350. (Could be interesting to review that research.)

Doing what we do 29.30
Psychoanalyst Arnold Goldberg 'The analysis of failure', about psychoanalysis
'We do what we do and explain both success and failure on the basis of the theoretical approach that is most congenial to us.'

Addiction to psychoanalytical beliefs 30.00
Heinz Kohut's book of 1981 'How does analysis cure?'
'in the largest number of instances, a future analyst's training commits him ... to a particular set of theoretical beliefs. With very few exceptions ... the analyst does not stray from these beliefs, which he comes to make his own. Rather, he defends them loyally, displaying hostility and contempt toward those who do not share them. ... I do not believe that groups whose members display such deep and unswerving loyalty to specific sets of theories are encountered with such frequency in other sciences.'

Taking a break, and I'm only half way through. Thanks @Haveyoutriedyoga, there's a lot in that presentation.
 
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Hutan said:
Mollon really seems to be having an internal struggle. He seems to love Freud and the idea of psychoanalysis but is acknowledging, with the help of some great quotes, that psychoanalysis has considerable risks and problems.

Despite my initial impression (edit - he has a couple of technical issues), I found much in this that was relevant and/or interesting:


First slide: 'Research indicates psychotherapy is often not very effective in alleviating people's problems and can sometimes leave people in a worse state.
but : 'The original and simple mode of therapy developed by Freud has become perverted in a variety of ways'

Bad experiences
'An NHS patient with severe regional pain syndrome (which is a terrible degenerative condition triggered by an injury) will soon be better if she has CBT. Absurd.'

'A patient is told that CBT will cure her anxiety - when it does not, she experiences even more panic.'

'A patient is referred for psychotherapy because of 'unexplained medical symptoms' - that catch-all phrase that is commonly used, and it's usually used with an implication that the person making that diagnosis thinks the problems are somehow of a psychological nature. But in reality that person has a serious disease, such as Lyme disease or Ehlers-Danlos Syndrome, hypermobility, both of which can give rise to a whole range, multiple physical or psychological issues.'

The case of Osheroff 10 mins
(somewhat surprisingly, the quote is from a book by E. Shorter. Oddly, because the case seems to favour medical intervention over talking therapy and Shorter has been a strong advocate for psychosomatic medicine.)
A doctor experiencing psychosis spent 7 months undergoing talk therapy, during which he lost his practice and his marriage, and was subsequently cured in a second institution with psychotropic medicine. He sued the first institution.

Dangers of emotional arousal 13 mins
'Interventions that risk increasing a person's feeling of being stigmatised or in which they are blamed for not meeting intervention targets, have been held to increase helplessness and self-blame, and so undermine a sense of self-efficacy.' There's an academic paper referenced for that quote, which might come in useful.

Hazards of CBT 14.45 mins
'CBT shifts responsibility onto the individual for engagement and conduct of the techniques. A recipient of this may feel guilty if the treatment does not result in the expected improvements, without realising that there are many other factors that may affect response.'

Dangers of psychodynamic therapy. 16.00 mins
'A potential consequence of externalising attributions of current difficulties to the behaviour of others (particularly parents) is estrangement and passive adoption of the victim role.' (I think this is a real danger where people are told that their ME/CFS symptoms are a result of childhood trauma.)

ADHD 21.30
'ADHD as a model of avoiding reality'. Mollon's description of ADHD ('Unrestrained narcissism' and 'pursuit of pleasure') struck me as very judgemental.

Freud - and outline of psychoanalysis 24.00
I thought the next slide on Freud's views of what the psychonanalyst should be doing was actually a better example of narcissism - the assumption that the psychoanalyst knew best. It's quite a freudian juxtaposition, I thought. Freud is quoted as 'Our knowledge is to make up for his ignorance and to give back his ego mastery over the lost provinces of his mental life. This pact constitutes the psychoanalytic situation '. Mollon approves, saying it is very good and sensible.

(but) Psychotherapy is sometimes not very effective 25.00
Quotes 'The Great Psychotherapy Debate' Bruce Wampold
Some percentages given on outcomes e.g. 15-24% of adolescents leave therapy in a worse state than when they started.

'Much hyped NHS IAPT Programme' (Parry et al) Only 6% of people referred to the programme recovered. This figure isn't publicised.'
(Could be worth tracking that paper down if we don't have it already.)

The most consistent finding in psychotherapy research is that there is very little difference between different sorts of therapies. The difference is between therapists.

Psychotherapists' Blind spot 28.00
90% of psychotherapists think that their outcomes are better than average.
Lambert did some research asking therapists to identify patients deteriorating under psychotherapy and likely to leave therapy worse off, and concluded 'psychodynamic therapists are usually over-confident in their clinical judgement'. Only one of 40 therapists, a trainee, was able to identify one such person, even though the researchers identified 40 such people out of 350. (Could be interesting to review that research.)

Doing what we do 29.30
Psychoanalyst Arnold Goldberg 'The analysis of failure', about psychoanalysis
'We do what we do and explain both success and failure on the basis of the theoretical approach that is most congenial to us.'

Addiction to psychoanalytical beliefs 30.00
Heinz Kohut's book of 1981 'How does analysis cure?'
'in the largest number of instances, a future analyst's training commits him ... to a particular set of theoretical beliefs. With very few exceptions ... the analyst does not stray from these beliefs, which he comes to make his own. Rather, he defends them loyally, displaying hostility and contempt toward those who do not share them. ... I do not believe that groups whose members display such deep and unswerving loyalty to specific sets of theories are encountered with such frequency in other sciences.'

Taking a break, and I'm only half way through. Thanks @Haveyoutriedyoga, there's a lot in that presentation.
Click to expand...
Thanks for pulling that out, didn't have it it me!

If I find the slides anywhere I'll share them here.

He seems like an interesting fellow, does 'energy healing'....(but also doesn't claim it cures anything).

As someone with ADHD I was also struck by the statement he made there, I watched his video on ADHD and found I most of it very sensible, but he dies mention 'narcisism', I think he's using the term differently to what we understand narcistic personality (?disorder) to mean in that he is talking about the internal relationship between the ego, superego and id (I'll explore that more one day because its a long time since I did A level psych, but that's my first impression).

ETA
I have experience some of the harms he mentions - CBT guilt, inappropriate CBT, poorly applied therapy, being pushed to feel victimised in a way that was unhelpful and distressing, surfacing issues without making appropriate support available to deal with them - that last one I think did immeasurable damage.
 
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Goals that are not legitimate 37.00
Include:
  • offering formulas for illusory happiness
  • persuading the client to adopt the therapist's world view, values or life strategies
  • the therapist as the "one who knows" - the analyst is not in possession of special insights or knowledge concerning the secrets of life
(think CBT and the emphasis on producing management plans with goals)

A book of a German woman's account of undergoing psychotherapy 42.30
von Drigalski - Flowers on Granite
"Doubting the analyst would mean questioning the whole analysis, one's entire personal commitment, the point of the expense of time, emotion and money ... To doubt the analyst and all institutions his authority is based on requires self-confidence, something that I for one very soon lost."
"The fact that he had been so annoyed with me was my fault ... I was a difficult, complicated, sly person ... robbing him ... of power and potency. He was the recognised analyst and I was the hard case."
"He insisted on his own interpretation"
"Readers who wrote to me from all over convinced me that deterioration in psychoanalysis is teh rule rather than the exception"

"All things considered, having both been in therapy and dispensed it for many years, I would now take the position that the climate created by psychoanalysis destroys human relations, and that by and large, psychoanalytic treatment does more harm than good."
(Mollon struggles with this - after all he's given his life to this practice.)


Some of the ways analysis can become perverted 44.00
'Making hurtful interpretations; aggressively imposing a theory on a patient' (Mollon doesn't seem to have noticed he was making hurtful interpretations of the behaviour of people with ADHD just before.)

'Placing emphasis upon the patient's psychopathology - including pathologising aspects that are actually common in the population' (we've seen this again and again in ME/CFS - the suggestion that being sad and worried when your life comes to a screaming halt is depression and anxiety, and the depression and anxiety is somehow causing the illness.)

'Subtly denigrating or dismissing the patient's own insights and perspectives.'


Transmission 44.40
  • "The analyst adheres to a 'strong' theory - rigidly held, all-encompassing
  • The patients own preceptions, beliefs and emotions are constantly invalidated
  • The patient may leave
  • If the patient does not leave, the patient may identify with the aggressor, learn the theory and impose it on self and others
  • May result in a perverse and cultish variant"
(think BPS, LP, ...)

Alienating impacts of diagnostic labels ( e.g. functional illnesses) 45.00
Diagnosis has commercial implications. The worse the diagnosis, the more money the institution earns. But the person identifies with the diagnosis.


How to fail as a therapist 47.30
Schwartz and Flowers - 50 ways to lose or damage your patients
  • presuming to know too much
  • ignoring science
  • failing to provide an appropriate therapy for the client's condition

Ways of minimising risk of harm 58.00
Ask 'if something were stopping you from getting better, what would you guess it might be? What comes to mind?'
'Convey that it is the client's deeper mind that knows what needs to be addressed.'
(I think it can just as as easily be a way to cause harm if the person's illness has a physical cause. How is the patient supposed to work out what might make them better if the doctor can't? I think it's a recipe for giving all sorts of wrong ideas credence. Probably though the approach is helpful with addiction or harmful patterns of behaviour.)

I have to give Mollon credit - he has reflected on the topic of how psychotherapy can harm pretty comprehensively. It takes some courage and intelligence to look critically at your beliefs, and he seems to have spent time doing that.
 
Merged thread
Not all therapy is a force for good. I give you exhibit A: the actor Jonah Hill : by Martha Gill

Article in Guardian
Can therapy be bad for you? There’s a strange omission in the way we tend to talk about psychotherapy, which has come to be regarded in the culture as a sort of unalloyed good, something almost everyone should have a go at.

We are happy to accept that this interaction – a conversation between therapist and client – is capable of changing our psychology in positive ways, even “transforming lives”. But we don’t extend the logic. If therapy is so powerful, isn’t there a risk it can harm us too?

Last week, psychotherapy came in for a rare bit of scrutiny after a media furore surrounding Jonah Hill, the Hollywood actor-producer.
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Mindfulness is billed as an innocuous sort of therapy. Yet one recent review of mindfulness lessons in secondary schools found it prompted no change in the mental health of students other than to make those with existing symptoms slightly worse.


There is less research into the harms that therapy might do to friends or relatives of clients
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There are problems with evidence all round. Glenys Parry, emeritus professor of psychological services research at the University of Sheffield, says there is an “allegiance bias”, where psychotherapists conducting research trials tend to find results that favour their own brand of treatment. A 2017 review of how research evidence has been summarised found that only a few of them met the highest standards of unbiased analysis.

It is only recently, too, that researchers have become interested in the idea that therapy might have adverse effects.
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Not all therapy is a force for good. I give you exhibit A: the actor Jonah Hill | Martha Gill | The Guardian

(she doesn't know the half of it......)

@Brian Hughes @Joan Crawford
 
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Moved posts
Reading the letters in today’s Guardian on statutory regulation of psychotherapists only emphasis to me what a mess the whole industry is in: https://www.theguardian.com/society...otherapists-will-welcome-statutory-regulation

To me, the problem is not about accreditation from regulatory bodies. The problem is that the regulatory bodies don’t seem to understand the problems with the research upon which their standards are based. I’m not an expert but from the outside, and through my experience with ME/CFS, the industry seems to be more like a religion than a science.

How can any regulatory body allow someone to charge £120 an hour on the premise than they can talk patients out of ME/CFS?
 
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Robert 1973 said:
Reading the letters in today’s Guardian on statutory regulation of psychotherapists only emphasis to me what a mess the whole industry is in: https://www.theguardian.com/society...otherapists-will-welcome-statutory-regulation

To me, the problem is not about accreditation from regulatory bodies. The problem is that the regulatory bodies don’t seem to understand the problems with the research upon which their standards are based. I’m not an expert but from the outside, and through my experience with ME/CFS, the industry seems to be more like a religion than a science.

How can any regulatory body allow someone to charge £120 an hour on the premise than they can talk patients out of ME/CFS?
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My psychotherapist is very good, I’ve had some who were not. I’m certainly not paying anything like £120 per hour. I do think it should be a protected title, if only to knock the “human givens psychotherapists” out of the field.
 
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