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.