site banner
PaperclipPerfector  10mo ago (text post)   26363 thread views

Culture War Roundup for the week of January 8, 2024

This weekly roundup thread is intended for all culture war posts. 'Culture war' is vaguely defined, but it basically means controversial issues that fall along set tribal lines. Arguments over culture war issues generate a lot of heat and little light, and few deeply entrenched people ever change their minds. This thread is for voicing opinions and analyzing the state of the discussion while trying to optimize for light over heat.

Optimistically, we think that engaging with people you disagree with is worth your time, and so is being nice! Pessimistically, there are many dynamics that can lead discussions on Culture War topics to become unproductive. There's a human tendency to divide along tribal lines, praising your ingroup and vilifying your outgroup - and if you think you find it easy to criticize your ingroup, then it may be that your outgroup is not who you think it is. Extremists with opposing positions can feed off each other, highlighting each other's worst points to justify their own angry rhetoric, which becomes in turn a new example of bad behavior for the other side to highlight.

We would like to avoid these negative dynamics. Accordingly, we ask that you do not use this thread for waging the Culture War. Examples of waging the Culture War:

  • Shaming.

  • Attempting to 'build consensus' or enforce ideological conformity.

  • Making sweeping generalizations to vilify a group you dislike.

  • Recruiting for a cause.

  • Posting links that could be summarized as 'Boo outgroup!' Basically, if your content is 'Can you believe what Those People did this week?' then you should either refrain from posting, or do some very patient work to contextualize and/or steel-man the relevant viewpoint.

In general, you should argue to understand, not to win. This thread is not territory to be claimed by one group or another; indeed, the aim is to have many different viewpoints represented here. Thus, we also ask that you follow some guidelines:

  • Speak plainly. Avoid sarcasm and mockery. When disagreeing with someone, state your objections explicitly.

  • Be as precise and charitable as you can. Don't paraphrase unflatteringly.

  • Don't imply that someone said something they did not say, even if you think it follows from what they said.

  • Write like everyone is reading and you want them to be included in the discussion.

On an ad hoc basis, the mods will try to compile a list of the best posts/comments from the previous week, posted in Quality Contribution threads and archived at /r/TheThread. You may nominate a comment for this list by clicking on 'report' at the bottom of the post and typing 'Actually a quality contribution' as the report reason.

7
Top Bottom Old Controversial Comments
Jump in the discussion.

No email address required.

Assuming counseling is highly effective. I’ve never seen someone start therapy graduate from therapy. I have seen people with illness stop going to see the specialist once cured.

I think therapy is a racket.

Anecdotally, I've started therapy and been discharged a few times. First time, college counselor kept asking me if I was suicidal in a way that started to seem like she was encouraging it, then when this led to no changes after several sessions, said to just stop coming. (The South Park script for this one basically writes itself.). The most recent happened because the medication seemed to be working and the therapy side of things was just kinda coasting.

Basically, college counselors suck. Male therapists are more likely to try to problem-solve, if you can find one who wasn't trained specifically not to problem-solve (Dr. K of Healthy Gamer has videos on this, but he puts out so many videos it's a pain to dig up one in particular when commenting from my phone). And a therapist/psychiatrist team is better than either separately. Also, Dr. K's recommendations are better than any therapist I've ever dealt with (the only one that came close, I lost because of losing my insurance for a few months).

I plan to become a psychiatrist, and I think therapy is overrated, at least when considering the vocal segment of the Overly Online who think everyone should be in therapy.

But it is possible to overhype something that is good for some people, some of the time, and the research I've read shows that therapy is pretty effective for many mental disorders, often being considered the first line intervention, such as for depression, anxiety, and so on.

And there are many different types of therapy, from the bullshit Freudian and Lacanian kind to the much better validated CBT. The thing is, even the shittiest forms of therapy that exist, such as the former two examples that are built off pure pseudoscience, work empirically, being better than placebo (or at least no therapy at all), though CBT is usually better. I wager much of the benefit in any of them is purely from the simulation of a helpful, non-judgemental "friend" who'll let you vent to your hearts content and won't tattle on the pain of their friend-card being retracted, and while you could substitute that for an actual friend, apparently those are getting harder to come by and have scheduling conflicts.

Besides, most reputable therapists (especially the ones who aren't into the Freudian crap) at least pay lip-service to the notion that their clients should always be temporary, and that they should be directed elsewhere if several sessions show no benefit. And if the client is showing up to sessions after they're satisfied it's not working, then I lay the blame for their stupidity on them. If they still want to go, well apparently they're getting their money's worth somehow. People go for haircuts and manicures even when the damn keratin just keeps growing back, and barbers aren't a scam.

Don't discount the value of "Freudian" psychotherapy. Part of this is driven by the usual "all the good ideas associated with this have been stolen and become core tenants of the successors" bit. You'd be surprised how much of his stuff is still present and useful.

The other piece is that the "true successor" actually works great. Psychodynamic psychotherapy is probably the most direct on that front, and if you talk to someone who knows CBT, DBT, and Psychodynamic therapy well they'll point out it is mostly all the same shit just with different words for the same concepts.*

The thing CBT primarily does differently is that it attempts to operationalize things by adding in components of homework, written self reflection and so on, but the fundamental insights are essentially the same.

It's tempting to think they are "different classes" but it's more like going to a calculus lecture, and then doing another course with the same content but you get problem sets afterwards.

There are purists out there, especially in Europe but generally people just roll their eyes at them.

Care to share those studies? How many of them are longitudinal?

I originally read that on the Wikipedia page, and when I tried to hunt down the citations, linkrot has eaten the Google Books excerpt that was supposedly cited, at least the one supposedly claiming that metanalysis showed they were all equivalent. However, after some hunting, I did find that claim in a different, well cited meta analysis down below.

https://en.wikipedia.org/wiki/Psychotherapy

Large-scale international reviews of scientific studies have concluded that psychotherapy is effective for numerous conditions.[8][22]

One line of research consistently finds that supposedly different forms of psychotherapy show similar effectiveness. According to The Handbook of Counseling Psychology: "Meta-analyses of psychotherapy studies have consistently demonstrated that there are no substantial differences in outcomes among treatments". The handbook states that there is "little evidence to suggest that any one psychological therapy consistently outperforms any other for any specific psychological disorders. This is sometimes called the Dodo bird verdict after a scene/section in Alice in Wonderland where every competitor in a race was called a winner and is given prizes".[151]

Further analyses seek to identify the factors that the psychotherapies have in common that seem to account for this, known as common factors theory; for example the quality of the therapeutic relationship, interpretation of problem, and the confrontation of painful emotions.[152][153][page needed][154][155]

Outcome studies have been critiqued for being too removed from real-world practice in that they use carefully selected therapists who have been extensively trained and monitored, and patients who may be non-representative of typical patients by virtue of strict inclusionary/exclusionary criteria. Such concerns impact the replication of research results and the ability to generalize from them to practicing therapists.[153][156]

However, specific therapies have been tested for use with specific disorders,[157] and regulatory organizations in both the UK and US make recommendations for different conditions.[158][159][160]

The Helsinki Psychotherapy Study was one of several large long-term clinical trials of psychotherapies that have taken place. Anxious and depressed patients in two short-term therapies (solution-focused and brief psychodynamic) improved faster, but five years long-term psychotherapy and psychoanalysis gave greater benefits. Several patient and therapist factors appear to predict suitability for different psychotherapies.[161]

Meta-analyses have established that cognitive behavioural therapy (CBT) and psychodynamic psychotherapy are equally effective in treating depression.[162]

The bolded section is the one I can't easily verify, at least not when it's 9 am and I've been up all night studying.

Specifically regarding CBT, I found the following metanalysis-

https://pubmed.ncbi.nlm.nih.gov/23870719/

Results: A total of 115 studies met inclusion criteria. The mean effect size (ES) of 94 comparisons from 75 studies of CBT and control groups was Hedges g = 0.71 (95% CI 0.62 to 0.79), which corresponds with a number needed to treat of 2.6. However, this may be an overestimation of the true ES as we found strong indications for publication bias (ES after adjustment for bias was g = 0.53), and because the ES of higher-quality studies was significantly lower (g = 0.53) than for lower-quality studies (g = 0.90). The difference between high- and low-quality studies remained significant after adjustment for other study characteristics in a multivariate meta-regression analysis. We did not find any indication that CBT was more or less effective than other psychotherapies or pharmacotherapy. Combined treatment was significantly more effective than pharmacotherapy alone (g = 0.49).

Conclusions: There is no doubt that CBT is an effective treatment for adult depression, although the effects may have been overestimated until now. CBT is also the most studied psychotherapy for depression, and thus has the greatest weight of evidence. However, other treatments approach its overall efficacy.

And when speaking of CBT as applied to more psychiatric conditions:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3584580/

We identified 269 meta-analytic studies and reviewed of those a representative sample of 106 meta-analyses examining CBT for the following problems: substance use disorder, schizophrenia and other psychotic disorders, depression and dysthymia, bipolar disorder, anxiety disorders, somatoform disorders, eating disorders, insomnia, personality disorders, anger and aggression, criminal behaviors, general stress, distress due to general medical conditions, chronic pain and fatigue, distress related to pregnancy complications and female hormonal conditions. Additional meta-analytic reviews examined the efficacy of CBT for various problems in children and elderly adults. The strongest support exists for CBT of anxiety disorders, somatoform disorders, bulimia, anger control problems, and general stress. Eleven studies compared response rates between CBT and other treatments or control conditions. CBT showed higher response rates than the comparison conditions in 7 of these reviews and only one review reported that CBT had lower response rates than comparison treatments. In general, the evidence-base of CBT is very strong. However, additional research is needed to examine the efficacy of CBT for randomized-controlled studies. Moreover, except for children and elderly populations, no meta-analytic studies of CBT have been reported on specific subgroups, such as ethnic minorities and low income samples.

Addressing the specific claims of similar efficacy to the forms of therapy based on pseudoscientific principles:

CBT for depression was more effective than control conditions such as waiting list or no treatment, with a medium effect size (van Straten, Geraedts, Verdonck-de Leeuw, Andersson, & Cuijpers, 2010; Beltman, Oude Voshaar, & Speckens, 2010). However, studies that compared CBT to other active treatments, such as psychodynamic treatment, problem-solving therapy, and interpersonal psychotherapy, found mixed results. Specifically, meta-analyses found CBT to be equally effective in comparison to other psychological treatments (e.g., Beltman, Oude Voshaar, & Speckens, 2010; Cuijpers, Smit, Bohlmeijer, Hollon, & Andersson, 2010; Pfeiffer, Heisler, Piette, Rogers, & Valenstein, 2011). Other studies, however, found favorable results for CBT (e.g. Di Giulio, 2010; Jorm, Morgan, & Hetrick, 2008; Tolin, 2010). For example, Jorm and colleagues (2008) found CBT to be superior to relaxation techniques at post-treatment. Additionally, Tolin (2010) showed CBT to be superior to psychodynamic therapy at both post-treatment and at six months follow-up, although this occurred when depression and anxiety symptoms were examined together.

Compared to pharmacological approaches, CBT and medication treatments had similar effects on chronic depressive symptoms, with effect sizes in the medium-large range (Vos, Haby, Barendregt, Kruijshaar, Corry, & Andrews, 2004). Other studies indicated that pharmacotherapy could be a useful addition to CBT; specifically, combination therapy of CBT with pharmacotherapy was more effective in comparison to CBT alone (Chan, 2006).

Anyway, therapy seems to beat placebo, and works synergistically with drugs, even if you cynically notice that therapy based off nonsense does much the same thing as more considered approaches, but it's not in dispute that it works. At least I have the consolation of being able to throw drugs at people instead of just talking at them if/when I'm a licensed shrink, for all the quibbling about if SSRIs work, ain't nobody claiming their ADHD isn't being helped when they're zooted up on stimulants.

You should consider that the sample you are looking at to make you believes this is abnormal. People graduate from therapy all the time. Most people with mental illness have some form of stressor(s), if that stressor goes away (mother in law, college, law school, better control over a chronic illness, they age into a better frontal lobe or coping mechanisms) then they may no longer need therapy.

People who are doing ok to well and get therapy anyway are less likely to stop, as are people who are doing really poorly, but plenty of the middle wraps up and moves on.

I think you may be seeing what you want to see here, given how commonly therapy stops.

I have graduated from therapy, and I know many others who have.

What is this place?

This website is a place for people who want to move past shady thinking and test their ideas in a court of people who don't all share the same biases. Our goal is to optimize for light, not heat; this is a group effort, and all commentators are asked to do their part.

The weekly Culture War threads host the most controversial topics and are the most visible aspect of The Motte. However, many other topics are appropriate here. We encourage people to post anything related to science, politics, or philosophy; if in doubt, post!

Check out The Vault for an archive of old quality posts. You are encouraged to crosspost these elsewhere.


Why are you called The Motte?

A motte is a stone keep on a raised earthwork common in early medieval fortifications. More pertinently, it's an element in a rhetorical move called a "Motte-and-Bailey", originally identified by philosopher Nicholas Shackel. It describes the tendency in discourse for people to move from a controversial but high value claim to a defensible but less exciting one upon any resistance to the former. He likens this to the medieval fortification, where a desirable land (the bailey) is abandoned when in danger for the more easily defended motte. In Shackel's words, "The Motte represents the defensible but undesired propositions to which one retreats when hard pressed."

On The Motte, always attempt to remain inside your defensible territory, even if you are not being pressed.


New post guidelines

If you're posting something that isn't related to the culture war, we encourage you to post a thread for it. A submission statement is highly appreciated, but isn't necessary for text posts or links to largely-text posts such as blogs or news articles; if we're unsure of the value of your post, we might remove it until you add a submission statement. A submission statement is required for non-text sources (videos, podcasts, images).

Culture war posts go in the culture war thread; all links must either include a submission statement or significant commentary. Bare links without those will be removed.

If in doubt, please post it!


Rules


Recommended Posts And Communities

Recommended Realtime Chats