Therapy is a curious practice. Therapy sounds like a scam, quackery, pseudo-science but it seems RCT consistently show therapy has benefits above and beyond medication & placebo.
Therapy has a long history. The Dodo verdict states that it doesn’t matter which form of therapy you do—they all work equally well. It follows that priests and shamans served the functions of a therapist. In the past, one would confessed ones sins to a priest, or spoken with the local shaman.
There is also the thing that therapy is strongly gendered (although this is changing), both therapists and their clientele lean female.
Self-Deception
Many forecasters will have noticed that their calibration score tanks the moment they try to predict salient facts about themselves. We are not-well calibrated about our own beliefs and desires.
Self-Deception is very common, arguably inherent to the human condition. There are of course many Hansonian reasons for this. I refer the reader to the Elephant and the Brain. Another good source would be Robert Trivers. These are social reasons for self-deception.
It is also not implausible that there are non-social reasons for self-deception. Predicting one-self perfectly can in theory lead one to get stuck in Procrastination Paradoxes. Whether this matters in practice is unclear to me but possible. Exuberant overconfidence is another case that seems like a case of self-deception.
Self-deception can be very useful, but one still pays the price for being inaccurate. The main function of talk-therapy seems to be to have a safe, private space in which humans can temporarily step out of their self-deception and reasses more soberly where they are at.
It explains many salient features of talk- therapy: the importance of talking extensively to another person that is (professionally) sworn to secrecy and therefore unable to do anything with your information.
I suspect that past therapists existed in your community and knew what you’re actually like so were better able to give you actual true information instead of having to digest only your bullshit and search for truth nuggets in it.
Furthermore, I suspect they didn’t lose their bread when they solve your problem! We have a major incentive issue in the current arrangement!
There’s a market for lemons problem, similar to the used car market, where neither the therapist nor customer can detect all hidden problems, pitfalls, etc., ahead of time. And once you do spend enough time to actually form a reasonable estimate there’s no takebacks possible.
So all the actually quality therapists will have no availability and all the lower quality therapists will almost by definition be associated with those with availability.
Edit: Game Theory suggests that you should never engage in therapy or at least never with someone with available time, at least until someone invents the certified pre-owned market.
Edit: Game Theory suggests that you should never engage in therapy or at least never with someone with available time, at least until someone invents the certified pre-owned market.
That would be prediction-based medicine. It works in theory, it’s just that someone would need to put it into practice.
[skipping several caveats and simplifying assumptions]
Now, when you get those 200 resumes, and hire the best person from the top 200, does that mean you’re hiring the top 0.5%?
“Maybe.”
No. You’re not. Think about what happens to the other 199 that you didn’t hire.
They go look for another job.
That means, in this horribly simplified universe, that the entire world could consist of 1,000,000 programmers, of whom the worst 199 keep applying for every job and never getting them, but the best 999,801 always get jobs as soon as they apply for one. So every time a job is listed the 199 losers apply, as usual, and one guy from the pool of 999,801 applies, and he gets the job, of course, because he’s the best, and now, in this contrived example, every employer thinks they’re getting the top 0.5% when they’re actually getting the top 99.9801%.
Thank you practicing the rationalist virtue of scholarship Christian. I was not aware of this paper.
You will have to excuse me for practicing rationalist vice and not believing nor investigating further this paper. I have been so traumatized by the repeated failures of non-hard science, I reject most social science papers as causally confounded p-hacked noise unless it already confirms my priors or is branded correct by somebody I trust.
As far as this particular paper goes I just searched for one on the point in Google Scholar.
I’m not sure what you believe about Spencer Greenberg but he has two interviews with people who believe that therapist skills (where empathy is one of the academic findings) matter:
I internalized the Dodo verdict and concluded that the specific therapist or therapist style didn’t matter anyway. A therapist is just a human mirror. The answer was inside of you all along Miles
Why (talk-)Therapy
Therapy is a curious practice. Therapy sounds like a scam, quackery, pseudo-science but it seems RCT consistently show therapy has benefits above and beyond medication & placebo.
Therapy has a long history. The Dodo verdict states that it doesn’t matter which form of therapy you do—they all work equally well. It follows that priests and shamans served the functions of a therapist. In the past, one would confessed ones sins to a priest, or spoken with the local shaman.
There is also the thing that therapy is strongly gendered (although this is changing), both therapists and their clientele lean female.
Self-Deception
Many forecasters will have noticed that their calibration score tanks the moment they try to predict salient facts about themselves. We are not-well calibrated about our own beliefs and desires.
Self-Deception is very common, arguably inherent to the human condition. There are of course many Hansonian reasons for this. I refer the reader to the Elephant and the Brain. Another good source would be Robert Trivers. These are social reasons for self-deception.
It is also not implausible that there are non-social reasons for self-deception. Predicting one-self perfectly can in theory lead one to get stuck in Procrastination Paradoxes. Whether this matters in practice is unclear to me but possible. Exuberant overconfidence is another case that seems like a case of self-deception.
Self-deception can be very useful, but one still pays the price for being inaccurate. The main function of talk-therapy seems to be to have a safe, private space in which humans can temporarily step out of their self-deception and reasses more soberly where they are at.
It explains many salient features of talk- therapy: the importance of talking extensively to another person that is (professionally) sworn to secrecy and therefore unable to do anything with your information.
I suspect that past therapists existed in your community and knew what you’re actually like so were better able to give you actual true information instead of having to digest only your bullshit and search for truth nuggets in it.
Furthermore, I suspect they didn’t lose their bread when they solve your problem! We have a major incentive issue in the current arrangement!
There’s a market for lemons problem, similar to the used car market, where neither the therapist nor customer can detect all hidden problems, pitfalls, etc., ahead of time. And once you do spend enough time to actually form a reasonable estimate there’s no takebacks possible.
So all the actually quality therapists will have no availability and all the lower quality therapists will almost by definition be associated with those with availability.
Edit: Game Theory suggests that you should never engage in therapy or at least never with someone with available time, at least until someone invents the certified pre-owned market.
That would be prediction-based medicine. It works in theory, it’s just that someone would need to put it into practice.
This style of argument proves too much. Why not see this dynamic with all jobs and products ever?
Have you ever tried hiring someone or getting a job? Mostly lemons all around (apologies for the offense, jobseekers, i’m sure you’re not the lemon)
Yup. Many programmer applicants famously couldn’t solve FizzBuzz. Which is probably because:
But such people are very obvious. You just give them a FizzBuzz test! This is why we have interviews, and work-trials.
If therapist quality would actually matter why don’t we see this reflected in RCTs?
We see it reflected in RCTs. One aspect of therapist quality is for example therapist empathy and empathy is a predictor for treatment outcomes.
The style of therapy does not seem to be important according to RCTs but that doesn’t mean that therapist skill is irrelevant.
Thank you practicing the rationalist virtue of scholarship Christian. I was not aware of this paper.
You will have to excuse me for practicing rationalist vice and not believing nor investigating further this paper. I have been so traumatized by the repeated failures of non-hard science, I reject most social science papers as causally confounded p-hacked noise unless it already confirms my priors or is branded correct by somebody I trust.
As far as this particular paper goes I just searched for one on the point in Google Scholar.
I’m not sure what you believe about Spencer Greenberg but he has two interviews with people who believe that therapist skills (where empathy is one of the academic findings) matter:
https://podcast.clearerthinking.org/episode/070/scott-miller-why-does-psychotherapy-work-when-it-works-at-all/
https://podcast.clearerthinking.org/episode/192/david-burns-cognitive-behavioral-therapy-and-beyond/
I internalized the Dodo verdict and concluded that the specific therapist or therapist style didn’t matter anyway. A therapist is just a human mirror. The answer was inside of you all along Miles