# How does therapy help?



## ZJA (Sep 23, 2012)

I had a sucky childhood because of my dysfunctional family, and I think this caused my social anxiety. I never felt normal or carefree. I have a lot of things to say about it, if I went to a therapist would it help? What does a therapist do to help?


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## YellowLittleDucky (Mar 22, 2011)

Hello! 

I have been in therapy for a while. About 2.5 years now. And I will tell you therapy does help, if the patient is willing to work with a therapist and work hard at it. Therapists cannot do the work for you, and I think a lot of people think that is what they do. Like, if you told them all your problems, they will fix it for you. This is far from the truth. 

What therapists tend to do are the following: 
-the tactful therapists often try to establish an environment that feels really safe for the person in therapy
-they will ask questions about your life and get a feel for your background and childhood (VERY often) 
-then they think of ways to help you, sometimes they get creative 
-they will ask questions about you 
-And I think they try to put suggestions or ideas in your head (subtly or not) so that you might consider them 

Assuming you are compatible with your therapist, I think the patient has to make the therapist feel like they are able to be honest with them. It is a two way; and I think if you are doing therapy right, the patient will feel really vulnerable. And it's going to hurt and there will be tears. 

It's kind of like treating a highly infected and grotesque wound, it's going to sting for a VERY long time. But it gets better, and eventually healing and progress will begin.


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## Paul Hughes 2 (Sep 21, 2012)

Hi there

I work on the following principles:

1. Clients often / usually need to know why they behave or think in certain ways. They often tell me "I don't know why I a, b or c." I help clients to understand where they are and how they got there. This helps to make sense of the problem and often works to create a set of potential solutions.

2. Clients will often come to me with a problem but aren't always sure of a goal. They would like to be rid of something but aren't clear of what life will be like without it. I help clients to form a positive outcome rather than concentrate on the negation of something.

3. I will work to ascertain the client's strengths and will help them to both accept these strengths and to turn them to their advantage when striving towards those goals identified in point 2.

4. Clients will often focus on the end result of their journey and this will seem distant and too great a leap. I will commonly break the goal down into realistic chunks.

The world is how we perceive it to be. Assisting a client to see that their truth is subjective is a powerful thing. Many of the therapeutic tasks I set my clients will help them to see themselves and their worlds differently. The smallest change in behaviour or viewpoint can snowball into great changes.

Ultimately Carl Rogers' core conditions provide the context in which clients achieve change:

a) Empathy. I will work to understand the client and their feelings. I will assure them that they and their problems are understood. I may be the only person in their lives who will demonstrate this without bias or prejudice. 

b) Unconditional Positive Regard. My clients are all valuable human beings and I will not waver in treating them as such. No matter what they have done and no matter how they feel themselves to be, I will accept and value them.

c) Congruence. I offer myself as I am without artifice or pretense. I will be a real human being to whom they can relate and whom they can trust.

I like and value all of my clients. They will know this. (If I can't offer this then I will not take them as clients). I will act as a mirror in which they will see their true selves and potential.

Well, that's how I do it. A therapist is often the only person to whom a client has fully opened themselves. If a client can truly bare their soul to a therapist who still accepts them and who remorselessly demonstrates the three core conditions then the client will grow in confidence and strength.

It's late and I'm tired and I'm not certain that this is a wholly satisfactory explanation but I think it's close enough. I hope you find it helpful anyway.

I wish you all the best.

Paul


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## Sierpinski (Jun 17, 2012)

YellowLittleDucky said:


> And I will tell you therapy does help, if the patient is willing to work with a therapist and work hard at it.


I was in therapy for, if you total it all up, about 14 years. I am not aware of any improvement. I will say that what therapy "does help if the patient is willing to work with a therapist and work hard at it" actually means is that any lack of success will be blamed on the patient. It is a very cruel system. Unless you're a therapist.


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## theJdogg (Sep 18, 2009)

For me, therapy has helped considerably. My therapist focused on my childhood experiences to show me how my current worldview was created by my parents. He also helps me by talking about my current problems and ways I can work on my current anxiety. At this point in my life, I would have a difficult time coping without my therapist. It's breaking my bank, but it's worth it. 

Much of it depends on the therapist-client connection. If you and your therapist click then it helps a ton. It took me a while to find one I got on with. I think I saw 7-8 therapists before I found one that works.


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## Sierpinski (Jun 17, 2012)

theJdogg said:


> I think I saw 7-8 therapists before I found one that works.


I lost count of how many I've seen. Certainly way up in the double digits.


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## Paul Hughes 2 (Sep 21, 2012)

Sierpinski said:


> I was in therapy for, if you total it all up, about 14 years. I am not aware of any improvement. I will say that what therapy "does help if the patient is willing to work with a therapist and work hard at it" actually means is that any lack of success will be blamed on the patient. It is a very cruel system. Unless you're a therapist.


I think that's a little harsh and I'm sorry if it's your experience.


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## YellowLittleDucky (Mar 22, 2011)

Sierpinski said:


> I was in therapy for, if you total it all up, about 14 years. I am not aware of any improvement. I will say that what therapy "does help if the patient is willing to work with a therapist and work hard at it" actually means is that any lack of success will be blamed on the patient. It is a very cruel system. Unless you're a therapist.


I can only speak for my own experience though. In my experience, the patient has to work hard at it so that there is progress. But I didn't acknowledge the severity of a patient's problems.

It's been less than 4 years for me with progress to happen. Having said that, I had other support systems outside of therapy, plus no matter how much my parents screwed me over during my childhood years, I always knew they loved me. My social anxiety isn't the most severe case, either.

Are you saying the therapist and patient share equal blame if there is no progress? Anyway, I am sorry if I offended you. I meant for the average person who tries/takes responsibility (still not at the ownership stage in my life) or the person with milder cases of personal problems, usually there is progress.


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## Sierpinski (Jun 17, 2012)

YellowLittleDucky said:


> Are you saying the therapist and patient share equal blame if there is no progress? Anyway, I am sorry if I offended you. I meant for the average person who tries/takes responsibility (still not at the ownership stage in my life) or the person with milder cases of personal problems, usually there is progress.


I'm not sure if the concept of blame applies to anyone here. My concern is that psychotherapy is snake oil, which does not necessarily imply that therapists feel that that is what they are selling. Like "psychics," many of them probably fully believe in what they are doing.

Treatment is something I would very much want, if I believed in it. I'm currently taking St. John's wort, thinking that it might be helping with something. (Here's a plug: Kira seems to be more authentic than a lot of other brands of St. John's wort.)

I have had therapists who have made utterly bizarre mistakes. And as an academic, or former academic, I've known clinical psychologists as colleagues and am impressed by how delusional and cognitively disordered they can be. It's frightening to think that some of them actually have patients. They should be patients. And I'm not talking about mild disorders, but seriously disordered cognition and problems tracking reality. They can even make deadly mistakes: http://www.kidscomefirst.info/DeathByTherapy.pdf
Despite the "New Age" qualifier, I know that mainstream therapists, and psychiatrists, can make shocking mistakes, because I've been on the receiving end of some of their mistakes. And then they refuse to acknowledge that any mistake was made. Therapists often seem to be living in their own world, detached from reality.


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## Paul Hughes 2 (Sep 21, 2012)

What would you say to those clients / former clients who believe that they have been helped by their experience of therapy?


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## Sierpinski (Jun 17, 2012)

Paul Hughes 2 said:


> What would you say to those clients / former clients who believe that they have been helped by their experience of therapy?


It could be the placebo effect. Or it could actually be doing something. I don't know. One might say "What is wrong with therapy being a placebo?" Answer: it's too expensive, and sometimes too dangerous, to be an acceptable placebo. Placebos should be as cheap and harmless as sugar pills. What is needed are statistics. One problem with meta-analyses is that they can be tainted by publication bias.


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## YellowLittleDucky (Mar 22, 2011)

I'm a little skeptical of how the article is written. 

If your experience with therapy have been bad. what is a fair sample size? Like if you grouped a bunch of therapists together from English speaking regions with similar cultural backgrounds (UK, US, Austrailia, Canada...), how many of them will fit your description?


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## Paul Hughes 2 (Sep 21, 2012)

Sierpinski said:


> It could be the placebo effect. Or it could actually be doing something. I don't know. One might say "What is wrong with therapy being a placebo?" Answer: it's too expensive, and sometimes too dangerous, to be an acceptable placebo. Placebos should be as cheap and harmless as sugar pills. What is needed are statistics. One problem with meta-analyses is that they can be tainted by publication bias.


If we were to agree that therapy only works by placebo effect then why would that be a problem, should the problem be such that its resolution changed the clients life for the better? I have a former client who seems determined to send as many new clients to me as possible. I don't take testimonials (unethical) and her proselytisation on my behalf is entirely unsought after. She does this, she says, because I "changed her life." I was a new therapist when I saw her and she was a student. I thus charged her about $100 dollars for four sessions. I was glad for the experience at the time and was more than happy to help. Would you say that this was too expensive? If I had "changed her life" for five times as much money, would this have been too much? How much would be?

Is not your analysis of therapy affected by a rather more serious bias? Some poor therapists may blame clients for a failure to see positive results. I'm still at the stage where I look to myself for the occasional failure. Too much, I feel and am told. You do seem, however, rather keen to condemn an entire field of human endeavour on the basis of your own individual experience. I don't know you (and you don't know all therapists or all therapies) but is it not possible that your experience is due to something other than the wholesale failure of psychotherapy?

I appreciate that therapy isn't for everybody. I really do. There are, however, many vulnerable people on this site who might benefit from therapy and they may be put off by your determination to discount it wholesale at every turn. I think that would be a pity.


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## Sierpinski (Jun 17, 2012)

YellowLittleDucky said:


> I'm a little skeptical of how the article is written.


http://articles.cnn.com/2001-04-05/...newmaker-connell-watkins-rebirthing?_s=PM:LAW



YellowLittleDucky said:


> If your experience with therapy have been bad. what is a fair sample size? Like if you grouped a bunch of therapists together from English speaking regions with similar cultural backgrounds (UK, US, Austrailia, Canada...), how many of them will fit your description?


I'm not sure that I understand the question, but I think you are expecting me to outline precisely what would count as proof of inefficacy. I should think that the burden of presenting a good empirical case should rest on those who tell the world that therapy works. One problem with therapy is that it is so deeply ingrained in our culture that even questioning it automatically sounds fringe.


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## Paul Hughes 2 (Sep 21, 2012)

...by the way, I deny that I changed her life. I don't believe that therapists have that power. I helped her see that she could change her life all by herself She agreed on this when I pointed it out.


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## Paul Hughes 2 (Sep 21, 2012)

Sierpinski said:


> http://articles.cnn.com/2001-04-05/...newmaker-connell-watkins-rebirthing?_s=PM:LAW
> 
> I'm not sure that I understand the question, but I think you are expecting me to outline precisely what would count as proof of inefficacy. I should think that the burden of presenting a good empirical case should rest on those who tell the world that therapy works. One problem with therapy is that it is so deeply ingrained in our culture that even questioning it automatically sounds fringe.


It's not fringe at all. It's an entirely mainstream question. The difficulty comes in ironing out the manifold variables. You're not only comparing apples and oranges but every single variety within the two categories. Which is tastier?


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## Sierpinski (Jun 17, 2012)

Paul Hughes 2 said:


> If we were to agree that therapy only works by placebo effect then why would that be a problem, should the problem be such that its resolution changed the clients life for the better? I have a former client who seems determined to send as many new clients to me as possible. I don't take testimonials (unethical) and her proselytisation on my behalf is entirely unsought after. She does this, she says, because I "changed her life." I was a new therapist when I saw her and she was a student. I thus charged her about $100 dollars for four sessions. I was glad for the experience at the time and was more than happy to help. Would you say that this was too expensive? If I had "changed her life" for five times as much money, would this have been too much? How much would be?
> 
> Is not your analysis of therapy affected by a rather more serious bias? Some poor therapists may blame clients for a failure to see positive results. I'm still at the stage where I look to myself for the occasional failure. Too much, I feel and am told. You do seem, however, rather keen to condemn an entire field of human endeavour on the basis of your own individual experience. I don't know you (and you don't know all therapists or all therapies) but is it not possible that your experience is due to something other than the wholesale failure of psychotherapy?
> 
> I appreciate that therapy isn't for everybody. I really do. There are, however, many vulnerable people on this site who might benefit from therapy and they may be put off by your determination to discount it wholesale at every turn. I think that would be a pity.


A placebo can be almost anything, so I don't see why it should cost anything. I doubt that it would even have to involve another person, but the widespread emphasis on therapy draws attention away from this possibility.

"You do seem, however, rather keen to condemn an entire field of human endeavour on the basis of your own individual experience." Where is the evidence in its favor, other than evidence consistent with its being placebo?

"I don't know you (and you don't know all therapists or all therapies) but is it not possible that your experience is due to something other than the wholesale failure of psychotherapy?" Such as?


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## Paul Hughes 2 (Sep 21, 2012)

"Such as?"

a) all the therapists in your town are indeed crap by some strange co-incidence
b) your motivations in seeking therapy 
c) a million other reasons

"A placebo can be almost anything, so I don't see why it should cost anything. I doubt that it would even have to involve another person, but the widespread emphasis on therapy draws attention away from this possibility."

It hasn't deterred major companies from seeking the holy grail of a pill. Psychotherapy did nothing to prevent the emergence of SSRIs, for example. The emphasis, it would seem, has moved to pharmacological "solutions."

People are still quite commonly loathe to submit to psychotherapy - or at least to confess to it. Prozac is a far more socially acceptable alternative. 


"You do seem, however, rather keen to condemn an entire field of human endeavour on the basis of your own individual experience." Where is the evidence in its favor, other than evidence consistent with its being placebo?"

How would you measure the efficacy of a treatment which takes different people with different backgrounds with different problems and submits them to a field of therapy administered by different people using different approaches based on different philosophies and who ask different questions and utilise different techniques at different times and in different ways with each and every person in a different environment? 

We could survey every single client as to their level of satisfaction with the therapy they experienced. How would you then ensure that one person's six out of ten was precisely equal to another's when given as a result of different people using different approaches based on different philosophies and who ask different questions and utilise different techniques at different times and in different ways with each and every person in a different environment? 

Again, which is the best movie in the world? Which is the tastiest food? How would you find out? You already know this. It is an impossible question.

If you can devise a test which answers these questions then I assure you that psychotherapy would be interested to hear of it.

I am dying of cancer (not really) and therefore I shall go around condemning medicine to everyone who asks about the ability of doctors to deal with illness. Is this a reasonable response to my experience?

It is, however, proven that those who have a more positive view of treatment for cancer have a higher chance of survival. Shall we condemn this or accept that a positive attitude towards treatment of any kind, and to life in general, renders one more likely to receive an appropriate reward?


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## Sierpinski (Jun 17, 2012)

Paul Hughes 2 said:


> "Such as?"
> 
> a) all the therapists in your town are indeed crap by some strange co-incidence
> b) your motivations in seeking therapy
> ...


You have conceded my points.


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## Paul Hughes 2 (Sep 21, 2012)

Not at all. I have argued that even should your points regarding placebo be conceded, your ultimate conclusion is unproven and rests solely upon your subjective point of view.

I am unwilling to concede that psychotherapy is a "cruel system" because I have seen enough evidence (in my clients and in those of other therapists) to believe otherwise. You refuse to accept that psychotherapy is anything other than a cruel system because of your own singular experience. There may be others who agree with you, indeed, but there are others in this forum who state that therapy has helped them. Whether or not therapy is placebo is immaterial. Therapy helps some people and disappoints others. I never argued otherwise. Your view, however, extrapolates a universal conclusion from a limited set of results.

You ask for verifiable proof from my side whilst submitting a subjectively restricted body of "evidence" from yours.

I would suggest that we leave this discussion as it stands.


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## Sierpinski (Jun 17, 2012)

Paul Hughes 2 said:


> Not at all. I have argued that even should your points regarding placebo be conceded, your ultimate conclusion is unproven and rests solely upon your subjective point of view.
> 
> I am unwilling to concede that psychotherapy is a "cruel system" because I have seen enough evidence (in my clients and in those of other therapists) to believe otherwise. You refuse to accept that psychotherapy is anything other than a cruel system because of your own singular experience. There may be others who agree with you, indeed, but there are others in this forum who state that therapy has helped them. Whether or not therapy is placebo is immaterial. Therapy helps some people and disappoints others. I never argued otherwise. Your view, however, extrapolates a universal conclusion from a limited set of results.
> 
> ...


I would agree, since there is little point wasting my time having a written discussion with someone who can't even read.


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## Sierpinski (Jun 17, 2012)

ZJA said:


> I had a sucky childhood because of my dysfunctional family, and I think this caused my social anxiety. I never felt normal or carefree. I have a lot of things to say about it, if I went to a therapist would it help? What does a therapist do to help?


Returning to the original question: I would suggest that you at least consider less expensive and less risky alternatives, such as self-help books. You might at least try that first before resorting to a therapist. 10 Simple Solutions to Shyness is one book you might consider as a start.


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## Paul Hughes 2 (Sep 21, 2012)

Whatever you say. I hope it all works out for you.

Best wishes

Paul


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## Sierpinski (Jun 17, 2012)

Paul Hughes 2 said:


> Whatever you say. I hope it all works out for you.
> 
> Best wishes
> 
> Paul


You remarked that therapy is untestable, a very strong claim which I don't necessarily accept. But if it is untestable this surely is a strike against therapy. Untestable treatments are not to be recommended because there is no rational way of determining that they work. What is really odd is that you would actually consider untestability to be a point in favor of therapy. I am really amazed at your level of confusion.


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## Paul Hughes 2 (Sep 21, 2012)

I don't believe I said it was untestable. The following study, for example, shows that CBT is less effective than fluoxetine in the treatment of clinical depression. CBT and fluoxetine combined are more effective than either therapy used in isolation. CBT appears to be relatively easily tested because its subjects are commonly asked to numerically scale either their progress or the severity of their symptoms from session to session. You can average these results out, given a large enough sample, to provide a seemingly reliable measure of efficacy.

http://www.ncbi.nlm.nih.gov/pubmed/15315995

Anything can be tested. Anything. The validity of results obtained, however, is a different matter. The above survey neglects to discuss whether CBT trained therapists believe 12 weeks to be adequate. Health providers limit sessions according to budgets rather than to need. Who is to say whether 15 or twenty weeks would have seen 100% of clients improve with CBT? Furthermore, what this study doesn't explore is the incidence of relapse. Are those treated with CBT less likely to relapse than those who relied solely on prozac? Would feeding MDMA to suicidal clients over 12 weeks see them do as well as those on prozac? Interestingly, sugar pills showed the lowest degree of efficacy. CBT is, therefore, at least superior to placebo in this study.

Clinical depression returns an average of three times, I recall, and this survey doesn't show whether CBT techniques, once learned, can help prevent relapse and are thus more cost-effective in the long term than fluoxetine alone. Health providers who allocate resources as a result of this study, therefore, are acting on shaky ground. This study, by the way, is relatively well reputed. I recall using it whilst training.

This study surveyed clients from 13 different therapy centres. Were the CBT therapists in these parts inferior or superior, on average, to groups of therapists elsewhere? Prozac is uniform. Clients and therapists are not. Therein lies my problem with the reliability of such studies.

Studies show this and studies show that. Some studies show psychotherapy to be of marked benefit, others are ambivalent and others negative. I doubt the veracity of them all. People are unique, are thus difficult to measure and no study yet commissioned has been of a sufficient scale or quality to resolve the matter either way.

I have re-read my previous posts and nowhere have I said that the difficulty of testing psychotherapy is an argument in its favour. I would merely suggest that the inability to conclusively and prove its efficacy is not evidence of inefficacy.

I don't think that's confused.

Neither do I care to debate it further. You seem incapable of discussing the topic without resorting to ad hominem sneers ("confused" and "illiterate")and we are not discussing things with the same aim in mind. I would sincerely like to find a way of measuring the efficacy of therapy in a reliable manner. I use scaling with my clients on a regular basis and they are generally quite open in stating what has and what has not been helpful. I encourage and appreciate this. You, however, do seem truly determined to discourage as many people from psychotherapy as is possible - based merely upon the findings of a subjective self-study of one subject: yourself.


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## Sierpinski (Jun 17, 2012)

The possibility of publication bias threatens the objectivity of many previous reports of the efficacy of therapy, e.g. [http://bjp.rcpsych.org/content/196/3/173.full.pdf]. Hence, psychotherapists are selling treatment without even knowing if it really is efficacious.



Paul Hughes 2 said:


> You, however, do seem truly determined to discourage as many people from psychotherapy as is possible - based merely upon the findings of a subjective self-study of one subject: yourself.


Your claim that I am basing this entirely on my own experience is patently false, since I have been discussing concerns about placebo and publication bias all along. I am determined to discourage people from psychotherapy, because it is wrong to be silent. 110 years is more than enough time to establish efficacy for a form of treatment for which payment is expected. For this reason, the burden of proof rests with the providers as well as those who advocate therapy.


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## Keith (Aug 30, 2008)

To the OP. I find therapy to be a useful tool in my recovery from anxiety. Its nice to have someone to talk to for one, and there's a certain amount of catharsis that takes place. I have some issues from my past (PTSD) and talking about them has helped release some of the pain I've been holding on too all of these years. Also my relationship with myself is changing, I'm learning to like myself more. It is also good to bounce ideas off of someone that has a more objective view of the situation. For me its taken a long time and you have to do most of the work, the therapist can only point you in the right direction. For me therapy has proven useful, especially since I've added meditation and mindfulness in to the mix. Its slow progress if your problems are complex like mine, but better than going backwards. 

If you have the money to spare or are covered by insurance it might be worth at least giving it a shot. To me the most useful and effective thing i have tried is daily meditation, everyone is different and different things work. Like for me medication hasn't been effective at all in regard to my anxiety, and i have tried dozens of meds. Good luck


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## Sierpinski (Jun 17, 2012)

As for psychotherapy being placebo, note the following article: 

The Placebo Is Powerful: Estimating Placebo Effects
in Medicine and Psychotherapy From Randomized
Clinical Trials

Bruce E. Wampold, Takuya Minami, Sandra Callen Tierney, Thomas W. Baskin, and Kuldhir S. Bhati
J Clin Psychol 61: 835–854, 2005

Here is a key passage: "In psychotherapy, it has been claimed that treatments produce effects that are roughly twice as large as placebo effects (Lambert & Ogles, 2004; Wampold, 2001b). However, when psychotherapy placebos are well designed, the placebo effect approaches the treatment effect, a result consistent with pharmacological treatments of psychological disorders."

Indeed, you will find people who claim that psychotherapy helped them. You will also find people who claim that crystals helped them, that a faith healer helped them, etc. Utilizing the placebo effect is wise. Selling placebo is disgusting.


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