Why do new psychotherapies work, and then stop?

Originally published at: https://boingboing.net/2019/11/21/mutually-exclusive-pseudohisto.html


My dog is my therapy, I got lucky I guess.


My mom sent my dog to therapy when I was little*. I’ve had a …strange childhood.

*diagnosis: My dog was “depressed”. And my dad was displeased when he found out my mom had paid for this session.


Speaking purely as a layman,

maybe the underlying ideas in the new therapy get widespread attention so patients show up already having received much of the benefit the therapeutic perspective brings

This, or something similar, would have been my guess.

I would wager it’s governed by a similar phenomenon as the one which sees the average performance on standardised IQ tests increase over time – the fundamental concepts involved are disseminated through the population, and the perspectives that they offer are already familiar to the patients before they see a therapist.

Whether this means that they have already benefited from them, however, or that they are still miserable despite being exposed to these perspectives and thus are predisposed to be resistant to gaining any benefit from them in a therapeutic setting…


Wow, that book cover brings back memories – my Mom gave it to me in about 1973 or so.


In a way I don’t think that answers the question, though. People do gradually get better at standardized IQ tests, but people don’t gradually get better at mental health, overall. If the therapies work and their principles are suffused into culture, shouldn’t that make everyone a little better off? If you picked up CBT through osmosis then CBT isn’t going to help but you should already be at the line you’d be at after taking CBT. If you didn’t pick it up through osmosis then CBT shoudl help to the extent you didn’t.

I don’t really disagree with you, it’s just I think there is a deeper question about why we basically develop immunities to help as if they were poisons or diseases.


The theory I’m going with - the therapist and patient need to have a positive relationship, otherwise it doesn’t matter what kind of therapy it is, it’s going to fail.

A friend went off to war 20-some years ago. He came back injured & traumatized, and the VA tried, and nothing helped for 15 years. Then he read a psychotherapy book, and talked about it with a similarly messed up friend. Both are better now, and meet regularly to talk.
A family member was diagnosed with any number of mental illnesses, and went thru a dozen different drugs and psychiatrists. She randomly became involved with pet rescues, and is stable without drugs and kind and loving and a force for good - because of bad dogs.
I have had successful therapy, and unsuccessful therapy, and the difference was the therapists. In order to heal, you have to have a positive relationship with your healer.


I recall reading about an investigation that suggested it is genuinely possible to become addicted to self-help books over time for reasons such as this. (Perhaps someone could find the link? My Internet access is a bit spotty right now.)

I don’t think we need a study. Obviously they aren’t addictive in a physiological sense, but in the sense that they could lead to obsessive use and associated harmful behaviours basically anything that changes your mood in any way can be addictive. I guess the question is whether there are a few isolated cases or whether there’s a real trend.

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I’m going to go with therapy and self help books help by giving back a sense of agency over your life. YOU can fix yourself and here’s how…
The change the advice engenders does make life better for a while until you realize that life still sucks and much of it is not under your control. So you look for the next magic fix that will make your life as good as all the smiling people in the media. Rinse and repeat.

I’d call it temporary toxic optimism, but that is probably just my cynicism talking.

*Therapy with a trained professional is helpful if you are matched with the right person/therapy for you. Please don’t construe my comment to say it doesn’t help.


Studies suggest that the affective bond between clinician and client is the main driver of success in therapy, regardless of treatment modality. marence above has it right!


It’s is possible the thrill of engaging with a new therapy and feeling the early successes might give little dopamine hits that could become physiologically addictive.

I know from my times on the couch that early on, early sessions cherry picked the easiest breakthroughs, and months later things slowed down as we got around to the deeper and more difficult issues. Things went from yay another easy breakthrough to… fuck this is hard I will in my car in the parking garage crying if anyone needs me.

I could see someone jumping from therapy to therapy chasing that early good feeling and avoiding the harder less exciting work there is to be done. Some combination of behavioral addiction plus whatever good chemicals the brain makes in response to the newest therapy that will fix everything easy peasy.


I’ve had four counsellors/therapists for different things over the years. Two I did not click with, one horribly so, but the two that I did were great.

Respect works both ways, too. So does trust and being open. Sometimes it takes time to find the right person and treatment for you.


Same except it would have been 77 or so.

FWIW, I struggle to remember any aspect of the book except “warm fuzzies” and “cold pricklies”, which I think says a lot about long term effectiveness of many of these things.

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This should be a band name.
Preferably klezmer but it’s not my band.


The other thing I remember is an illustration of one of the turtle characters cowering before a TV where a scary movie is playing (presumably demonstrating “cold pricklies”), with a tentacled alien on the screen going “glub blub.” That alien scared the shit out of me.

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If “I’m OK” and “You’re OK” then … aren’t we done?

Another flashback on seeing that cover.

My father was a HS English teacher, and occasionally had to take career development classes. One was on TA, and he came home with that book (maybe others) and some “warm fuzzies.” He was enthused about the concept, at least professionally. Didn’t keep him from coming home drunk three or four days a week. :-/

I remember that interactions between the turtle boy and a baby brother, and a thought balloon “I could have broken my shell!!”


It sounds like what’s happening is an inevitable part of treating new, exciting findings that confound current thinking as a “new breakthrough”

The reality of the situation is that anything that’s interesting enough to be hailed as a brand new therapy must have a few things in common:

  • It must be a novel result- therefore it must be newly studied, and have very little existing data about it.
  • If it gets hailed as a brand new therapy, then it must be surprising- It must confound our current ideas and be sufficiently different to our current thinking so as not to be considered as a mere "improvement " to our current methods
  • It must be communicated to the medical community and the general publis, and that communication gives rise to an understandable bias towards making your research stand out and be seen as important. This can lead to journalists and researchers over-emphasising the “breakthrough” element of the research (see below for a related article on why science communication is done so, so badly.)

With all these three elements in place, it’s easy to see why some of these exciting outliers fail to hold up when given more intense study. Under the rigorous gaze of empirical testing, many hopeful new breakthroughs turn out to be dead ends or just sink back into statistical noise, especially when dealing with a system as complex as the human brain. This is not a case of new treatments failing, it’s just the inevitable messiness of actual empirical study, which does not generally proceed by eye-catching headlines and heroic new ideas, but instead by gradual accumulation of evidence and the slow emergence of new and improved treatments and methodologies. Empiricism and the Scientific Method will not win many prizes for drama, but they work.


I absolutely agree that effective therapy is dependent on having the right therapist for you. I know for a fact that I’d benefit from therapy, but I’ve had such poor experiences with it (ie, my last therapist was so bad that he was brought before the board and fled the state) that I’m uncertain how to find the right person. I legitimately need therapy for my therapy.