The Lowdown on Psychotherapy

Juliette Kochenderfer-Moore writes:

I also question why some people want to work in therapy sometimes, and the endless job titles have my head spinning.

Is a  therapist the same as a counselor? What the hell is a psychotherapist? A psychoanalyst? Are a psychologist and psychiatrist the same thing?

Seriously. Most of them seem totally bored out of their minds at what they do for a living. Why are we paying bucket loads of money to go get labeled and undergo “treatment,” of which the success rate is dubious?

Most are not bored, most therapists enjoy what they are doing, I have liked most of my therapists, and I thought most of them were very smart.

Also it can be very good money. Licensed therapists can make a lot of money.

Anyone can be a “counselor” in California. Even you can. But hardly anyone does it because realistically, who is going to pay you good money to sit there and listen to their problems?

A psychotherapist is someone with a credential – in California, either a Clinical Psychologist, a Psychiatrist, a Masters in Social Work, or a Licensed Clinical Social Worker.

A psychoanalyst practices Freudian psychoanalysis. This seems to be going out, as a lot of it has not stood up to scientific scrutiny.

A psychologist is a Clinical Psychologist. They have a PhD. Most of them are extremely good.

A psychiatrist is an MD. They are medical doctors. I don’t like them quite as much as the Clinical Psychologists. I think Clinical Psychologists actually understand psychology and the psyche better than Psychiatrists. Nowadays Psychiatrists are mostly just drug pushers. If you want drugs, you need to go to a Psychiatrist.

Therapy is costly. I think psychotherapy is a luxury good that is available only in wealthy societies. You don’t really need it, but it can really make you feel better. I am convinced that many to even most 3rd World people could benefit from psychotherapy, but their societies are too poor, so they cannot afford these things.

Labeling is generally a good idea. Only 14% of the population has a personality disorder. That’s not a lot. Most people with a PD diagnosis definitely are very difficult people at best, I assure you. I say this because I have known a number of Personality Disordered persons for decades, and they are truly impossible and infuriating human beings. There is no way on Earth that is normal behavior. It’s not acceptable to act abrasive and annoying such that you screw up your own life and that of everyone around you. That’s not a definition of mental health.

Most people with anxiety disorders really have them. If you do diagnosis properly, and you put the person on the right drug, it is amazing what you can do.

I think it is incredible just how “syndromal” a lot of these conditions are. I work with OCD people, and this is a syndrome if I ever saw one. All of these people seem like they are reading off the same script. I know them so well that I can almost spot one half a mile away blindfolded. Also I can practically crawl up around in the brains of my clients and tell them exactly what they are thinking because I know exactly how this illness makes you think.

The Personality Disorders are also very “syndromal,” often shockingly so.

Why so many mental disorders look nearly as syndromal as physical disorders is a mystery, but I think a good answer might be that of all of the possible ways of acting crazy, humans are somehow limited to a small subset of all such craziness due to the limitations of the human brain and condition. In other words, because there are only a certain number of ways to go nuts, humans tend to go nuts in very syndromal like patterns that look a lot like physical illnesses in the way they seem to come as a “package.”

Some people are so nervous that they just do not function well. Others are going round and round about other anxiety like conditions. Panic Disorder is crippling. PTSD is a very bad illness.

Depression is real. I have known some depressives who simply cannot function at all due to extreme depression. It is almost like they have a physical condition.

Bipolar disorder is as straight up syndrome, and these people are just not well. It’s not even really ok to be hypomanic. They’re not rational, they don’t act very sensibly, and the irritable ones are insufferable jerks who quarrel and fight with everyone all the time. Full blown mania is so non-adaptive that the person almost needs to be committed so they don’t completely destroy their lives during the episode.

It’s not ok to be psychotic. Psychotic people cannot function and are often a danger to themselves or others. They desperately need to be treated.

Schizophrenia is a full-blown illness in which there is something wrong with their brains.

Many of these illnesses are highly genetic, with Manic Depression and OCD showing some of the highest loadings of all, near 85%. Obviously these people simply have something wrong with their brains.

Psychotherapy is overpriced, but we are all doing therapy with each other all the time. Anytime you talk to any of your friends or loved ones about any psychological stuff they have going and try to give them advice on how to deal with it, you are doing therapy. Anytime you try to help people to live their lives better, function better, quit making dumb mistakes and stop engaging in unhealthy behavior patterns, you are doing psychotherapy.

The problem is that most people do not want to help you get over your troubles or teach you how to function better and quit doing nonadaptive things. Also therapists have a lot of training, and they are simply better than your ordinary person off the street at such things.

But really anytime you talk to a very wise person who gives you a lot of good wisdom on how to live your life, solve your problems, function better and stop doing non-adaptive things, you are basically getting psychotherapy, as the best therapists are simply very wise people who help you by sharing some of their wisdom with you.

Psychotherapy works very well, and it certainly works as well as the competition.

What is the competition?

Get better on your own? Talk to your friends and family get them to talk you out of it? Go to church? Read some books? Get a girlfriend or boyfriend? Get a better job? Move to a new area? Join a cult? Join a self-help movement? Go to the gym? Read Manosphere Blogs and learn Game?

None of that stuff works as well as psychotherapy for helping people with diagnosed proven psychological disorders. And none of it works as well as psychotherapy for even problems in living, growth work (trying to grow as a person) or deep work (trying to delve into the depths of your psyche and figure yourself out).

The only thing that works better than psychotherapy for a lot of things is drugs. These are psychiatric drugs and they do have a lot of side effects.

Really the best treatment is psychotherapy + drugs.

I deal with OCD’ers. When OCD is very bad, I feel that psychotherapy is useless. The person’s mind is just too far gone for the therapy to do any good work. It’s like banging your head into a wall. You can do the therapy over and over, but it won’t sink in because there is something wrong with your brain. Therapy with a messed up brain is like filling up the gas tank of a car with serious mechanical problems. That gas won’t get you very well (in other words, it won’t even work well) until you fix the car so it can run well enough to even use the gas in the first place. Once you fix up the car, now you can put gas in it, change the oil, check the fluids and all of that, and that’s finally useful.

On the other hand, drugs alone don’t seem to really cut it. I have found that when you are on a really good drug, you can start using all the great stuff you learned in psychotherapy, and now the therapy really starts working. The sad thing is that psychotherapy works best on a fairly healthy brain. You have to get your brain into a fairly healthy place to where the therapy can even function at all.

6 Comments

Filed under Anxiety Disorders, Depression, Health, Medicine, Mental Illness, Mood Disorders, OCD, Personality Disorders, Psychology, Psychopathology, Psychotherapy, Psychotic Disorders, Schizophrenia

6 responses to “The Lowdown on Psychotherapy

  1. Juliette Kochenderfer-Moore

    Thanks for the clarification🙂

  2. Sam

    “…Most people with anxiety disorders really have them. If you do diagnosis properly, and you put the person on the right drug, it is amazing what you can do…”

    I’ve got this. I take buspirone for it. I don’t like the side effects[It makes me slow. I used to be a lot quicker and smarter] but anything…ANYTHING is better than feeling like “I”M GOING TO DIE RIGHT NOW”. They call the anxiety attacks I believe panic attacks are the more accurate term. I think it’s probably the same thing that people get when they have shell shock or PTSD. Something in your nervous system just starts releasing chemicals like your in battle or a life perils situation but you can’t shut it off. Don’t tell me about breathing or any of that. I know about that and while it works on small discomfort it does nothing on the big ones. The drugs don’t completely stop anxiety but they do stop the really bad ones. If you ever have anyone that has this something else that helps a great deal is “Animal Parade brand” ” Vanilla flavored Calcium Chewable” it also has magnesium in it. 2 or 3 chewed up while having an attack can calm you in five minutes or so. I have no financial interest in these folks.

    I think part of counseling works because we don’t have extended families any more. Grandparents used to do a lot of this but they’re not around all the time like they used to be. Grandparents can give some straightforward non judgmental advice.

  3. Ed

    If you are writing posts on therapy, you may be interested in this Sebastian Junger article on PTSD:

    http://www.vanityfair.com/news/2015/05/ptsd-war-home-sebastian-junger

  4. Jason Y

    Some of the drugs given to psychiatric patients are really dangerous. One, Resperidal, and this is no joke, actually causes men and boys to develop breasts. 😆 There were ads on TV offering financial compensation via lawsuits.

    Some other effects include hatred of the Confederate flag, and a fake bandwagon support for gay rights 😆

    • Jason Y

      In regards to Resperidal, what in the hell are these doctors giving kids?😆 Whether it be ritalin or whatever, they seem to be stuff to put kids to sleep, or weird them out, in order to control them.

    • Jason Y

      I think a lot of these doctors are creeps. I wouldn’t let them get near a child or teenager😆 They don’t know what in the hell they’re doing. They’re main specialty is putting children to sleep.

      However, they do a good job with giving kids anti-depressants, but that might not be a good thing. A kid’s emotions become, abnormal, too happy. Often they get into trouble. Of course, though it’s a sure fire way to destroy being a nerd, cause it completely destroys shyness, much like booze.😆

      Why can’t kids just be themselves without being hated and a nerd?

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