Does Psychotherapy Work?

Does psychotherapy work?

Millions of Americans engage in psychotherapy, women receiving treatment at approximately twice the rate of men. At Aporia, Bo and Ben Winegard discuss whether psychotherapy really works. They are extremely skeptical, based on a detailed analysis of the topic in search of reliable metrics. Their article is titled: "The Psychotherapy Myth: Contrary to the claims of the psychotherapy myth, humans can be resilient and tough-minded; they can suffer the slings and arrows of life without expensive interventions from “experts.”

Here is an excerpt from their conclusions:

Contrary to the claims of the psychotherapy myth, humans can be resilient and tough-minded; they can suffer the slings and arrows of life without expensive interventions from “experts.” . . .

Thus, a healthy culture should teach that life is often full of misery, dashed hopes, and thwarted desires; it should teach that agony, anguish, and despair are ineradicable parts of the human experience, not aberrant or fleeting intrusions; it should encourage more stoicism, more discipline, more sacrifice; and it should discourage cossetting, indulgence, and morbid contemplation. Reflecting obsessively upon grievances and hardships, like constantly fiddling with a wound, is unwholesome.

Furthermore, the idea that understanding the cause of one’s suffering is the key to curing it is dubious ...Often, the disease is not in the head, but in the society. And thus, even if psychotherapy were highly effective, it might be a dangerous distraction.

The idea that the good therapist is a highly skilled mental engineer who knows how to manipulate the complicated machinery of the human psyche has been memorably promoted in movies such as “Ordinary People,” and, if it were true, it might justify the exorbitant salary some therapists command. But alas, it is no truer than the Freudianism that spawned it; and despite its veneer of sophistication and scientism, psychotherapy ultimately remains a human interaction, purchased at great expense to the patient and perhaps to society.

People will always want to talk to other people about their miseries and insecurities, flaws and failures, hopes and dreams; and counselors and therapists will remain employed into the foreseeable future. Some may even do considerable good. But we hope they will drop the pernicious mythology, the exorbitant prices, and the complicated and often unnecessary licensing system and recognize the simple but tragic fact that many people are desperate for sympathetic social partners and will pay a lot of money for them. What is needed is not more expensively trained experts, but more real social relationships.

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False Facts Lead to Bad Legal Conclusions

In the recent affirmative action decision by the U.S. Supreme Court, Justice Jackson made a startling claim:

Dr. Vinay Prasad takes issue with the shoddy study on which Justice Jackson might well have relied upon in good faith. I will assume that neither she nor her law clerks have the necessary expertise for critically analyzing the study she cited for making the claim that Black doctors are twice as good at saving the lives of Black newborns. In this article, Dr. Prasad shows the skepticism one needs to show upon hearing such an extraordinary claim.

The paper in question is catastrophically flawed. First, consider that it is a bold claim that a white doctor is twice as likely to kill a black baby. The effect size (TWICE as likely!) is massive. . . .

Next, in my podcast from Aug 2020 I discuss why this paper is flawed (full podcast is 91 min. but relevant discussion runs from 1:31:00 to 0:52:00 mark). Those notes are also captured here.

  • If white doctors have so much worse outcomes, one would expect they are making different decisions in the care of neonates than Black doctors— but this paper cannot show the mechanism of the difference

  • The paper assumes doctor-baby pairings are quasi randomized, but that is unfounded assumption. It may not be quasi randomized and well off Blacks may be more likely to have Black doctors

  • A baby born is seen by a team of doctors— pediatricians, anesthesiologists, obs— which doctor is ascribed the ‘assigned provider’ per baby. What determines this assignment? (the authors do not provide this information)

  • Since, the paper was published it was revealed that some hospitals put a treating doctor on the form and others put the head of the unit. (massive bias)

  • A baby born is seen by a team— nurses, staff, doctors, etc— why are the races (and racial concordance) of these people not accounted for.

  • If a baby gets sick, and goes to NICU and dies, which doctor is ascribed responsibility. If NICU doctors have different racial make up than other doctors could this not bias results?

  • Broader issues of administrative data/ multiple hypothesis testing detailed in the episode.

Prasad also breaks down a second article claiming that Black doctors are substantially better at saving Black lives: "The Supreme Court’s affirmative action decision puts lives at risk."

Prasad sets forth the limitations on this second study, which also makes an extraordinary race-based claim:

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“Schools”

It's cheap and easy to put up a sign saying "School" on the front of a building. It's entirely another thing to run a functioning school. Many of our schools are among our institutions that are being rotted out on the inside. This is permanently hurting millions of people and threatening America's future. From City Journal:

No issue is more pressing in California than education. In late October, the state released scores for the first post-Covid-shutdown state standardized test, conducted earlier last year. The results were horrendous. Less than half of all students who took the Smarter Balanced test—47.1 percent—met the state standard in English language arts, down 4 percentage points from 2018–19. One-third of students met the standard in math, down 6.5 percentage points. Only 16 percent of black students and 9.7 percent of English learners met standards in math.

Not only did test scores plummet; the state’s chronic absenteeism rate has also skyrocketed. The no-show rate leapt from 14.3 percent in 2020–21 to 30 percent in 2021–22. (California defines chronic absenteeism as students missing 10 percent of the days they were enrolled for any reason.) But amazingly, during the 2021–22 school year, data showed that the state’s four-year high school graduation rate climbed to 87 percent, up from 83.6 percent in 2020–21.

How is this possible?

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