What Purpose Self Insight?

I’ve been enjoying the first season of HBO’s In Treatment.  While the patients and problems are skewed for dramatic effect, the detailed dialogue and dynamics seem quite realistic.  (My wife, who was a psychotherapist for many years, says so.)

It is jarring that sessions often end mid-conversation, but this is surely realistic.  Also striking is how much of what people say serves hidden agendas, of which speakers are unaware.  Much of therapy is showing people these hidden agendas.  I am convinced that therapists typically have a lot of insight about patients, insights that patients can also gain if they so choose.   I hear the ring of truth in their words.

Now back in ’07 I posted on Dawes on a review of psychotherapy effectiveness:

Someone chosen at random from the experimental group after therapy had a two-to-one chance of being better off … than someone … from the control group. … Therapists’ credentials – Ph.D., M.D., or no advanced degree – and experience were unrelated to the efficacy of therapy.  … The type of therapy given was unrelated to its effectiveness. … Length of therapy was unrelated to its success.

Psychotherapists continue to think otherwise. For example:

You ask if the therapist is licensed, … [or] had special certification or training in particular areas, and they can’t tell you. In fact at this point they probably tell you to lighten up.  Don’t fall into this trap. … My own bias is strongly supported by psychoanalysts and even the cognitive behavioral literature. All these sources agree that you should start treatment by consulting a well trained, widely experienced therapist.

This therapist also says:

More than perhaps any other profession, psychotherapy is lampooned mercilessly. … Psychotherapy is not a massage. It is not “unconditional positive regard” … Psychotherapy is not advice. …  A good way to think of this distinction … is … Does it foster insight.

Skeptics are probably right that credentials, experience, and length of therapy don’t matter, but therapists are also probably unfairly lampooned; they do offer powerful insights.  How can we reconcile these?  My guess: self insight just doesn’t help us much to overcome our problems; a sympathetic authoritative ear is enough.  We were probably built to be blind to these hidden agendas for good reason, so forcing awareness on average doesn’t help.

If so, why are “better” therapists in more demand?  If you’ve been reading this blog for a while, you can guess my answer:  status signaling.  We are more impressive people when we have more insight into ourselves, and we like to affiliate with therapists who are known to have impressive insights into their patients.   Note the obvious parallel with ordinary medicine: docs really do know a lot of impressive things, even though there is no correlation between health and medical spending.

So does self insight into our personal biases help us overcome them any better?  It is not obvious why they would.  My main hopes, such as they are, center on developing better institutions, and on the intellectual community slowly accumulating more total insight.   Personal insight is ephemeral and weak.

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  • http://michaelkenny.blogspot.com mike kenny

    this seems related to how a rationality in a person is affected by their relation to others. i sometimes wonder if it’s worth thinking about individual bias as a part of a bigger picture, how groups function–maybe it’s good to be biased in some contexts, because it serves some good–i think of lawyers who are biased for their client, but the overall trial process is one in which we tend to think the results are probably more unbiased than if you had one person reasoning things out, because the competing arguments target certain flaws in the opposing view.

    perhaps it would be profitable to think about how our rational processes work in the stone age environment, in typical situations when we would employ rationality and arguments. perhaps we might develop a ‘stone age rationality’ idea from this, if there hasn’t already been such an idea–how to work with our rational natures rather than against them in our novel modern environment. sometimes i feel like trying to overcome some biases feels a bit like forcing myself to walk on all fours–just unnatural. not to say overcoming bias isn’t worth doing–i just wonder what ways work best–i think of the metaphor of someone trying a conventional diet versus a paleo diet, and perhaps finding the paleo diet easier, because it works with his nature.

  • http://robertwiblin.wordpress.com Robert Wiblin

    Speaking of status signalling and affiliating with the impressive Robin, you’re affiliated with Oxford University! You should totally move that ‘sponsoring organisation’ box up to the top (or add it to the ob logo) so that people will take you more seriously.

  • http://www.nancybuttons.com Nancy Lebovitz

    As a general point, I’m pretty sure it’s more useful to become aware of process (when I feel W, I think Y, then feel Z and do A) rather than having a more generalized insight (I feel bad because of past event). Sometimes reassurance helps (past event really was bad). So can methods that lower background anxiety.

    Occasionally insight works– I’ve got one striking case in my life when it did, but I think getting at the moments when choice is possible is usually better.

  • http://shagbark.livejournal.com Phil Goetz

    Why would people choose psychotherapists to signal status, and then keep the fact that they are in therapy secret?

    • http://www.nancybuttons.com Nancy Lebovitz

      Can signaling theory include reassuring oneself about one’s own status, or would that have to be another theory?

    • Jess Riedel

      I think that this is an example where Robin’s phrasing is a bit unclear (to me, at least). Robin says things like “People associate with high status individuals to signal their own status” when I think he could better say “People have evolved the desire to associate with high status individuals because such associations typically signal their own status, which increases fitness.” That desire exists even though it is ineffective at signaling in this particular situation.

      In other words people are adaptation-executors, not fitness-maximizers.

      (Of course, it wouldn’t be correct to say that people are never consciously trying to signal status. I imagine it is typically a combination of conscious and unconscious factors at work. But I think in this situation the signaling must be purely unconscious, for exactly the reason you mention, Phil.)

      Robin, could you please comment?

      • http://hanson.gmu.edu Robin Hanson

        People do often let it be known that they are or have been in therapy. It is not clear how context sensitive are our evolved habits of affiliating with impressive folks. The exact degree is not especially important for the main overall predictions.

  • http://macroethics.blogspot.com nazgulnarsil

    because obviously MY problems are so nuanced and complex that they require a deeply insightful person to even tease out. consider the alternative narrative: any old schmuck can help me out.

  • http://t-a-w.blogspot.com/ Tomasz Wegrzanowski

    Phil Goetz: That can be explained by fitness maximizers vs adaptations executers. Assuming mechanism described in this post is all true, the instinct to associate with high status individuals would still work even if you wanted to keep the entire association secret, even if it would work less strongly.

    As an analogy people are unwilling to have one-night stands with unattractive partners, even when they want sex a lot. If they’re sure none of their friends will find out (like on holidays) their standards lower a little, but not that much.

  • Constant

    So does self insight into our personal biases help us overcome them any better?  It is not obvious why they would.

    Seems you’ve pulled the rug out from under this blog – at least, when “overcoming bias” was a more descriptive title, and at least as it was understood by many participants.

  • Jonathan Graehl

    So, the implication is that no matter the insightful response my therapist has, I won’t pay any attention to its content? All I’ll get out of the experience is a greater consideration that an outside view worth respecting exists?

    I’d like to think that I’d benefit from actual insights and observations. But if the claim is true, either most people can’t benefit from the content, or else it’s *very* easy to come up with the stuff that works (any therapist can do it equally well if they try).

  • aram

    You build elaborate logical towers on top of a base of there being “no relationship” between effectiveness and outward signs of quality, when I’m guessing that these studies really say that there is “no statistically significant” relationship.

    • http://hanson.gmu.edu Robin Hanson

      If the relation is there but weak, it doesn’t explain much of the behavior.

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  • http://infiniteinjury.org/blog/ TruePath

    This isn’t new news. An interesting little tidbit is that Timothy Leary gained his academic reputation partially on the basis of just such a study (showing that of people who were randomly assigned to recieve therapy or not for depression there was no/little difference in outcomes).

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