Genuineness, kindness, empathy, 'attunement', respect, compatibility You can't really study any of them, but surely they are the most important factors.
Although it seems strange that new therapies are developed every so often when therapies that work already exist, I've found in clinical practice that some therapies achieve better outcomes. I know this is not supported by empirical evidence but I certainly can't deny practice-based evidence. Perhaps it's because the therapist is more confident in, and buys more into, certain therapies and therefore come across more competent when delivering those approaches.
"Evidenced Based the therapeutic Practice" is a misnomer, as I think Dr Wampold is saying. First we do not know what the actual mechanism of pathology is in the patients. We do not know this and we should not represent that we do, we cannot test for a psychiatric disease and demonstrate physically, empirically, that it exists, let alone WHAT exists. Since we don't know what is wrong, when someone experiences positive change, we don't really know what was changed, or how it changed, or why it changed. Therefore the only evidence we have is that THIS treatment seems to be effective in this way with this disorder to some level of confidence but that it is rare that one technique is truly superior. Common Factors say the therapeutic alliance is a major factor in patient change/effective therapy. The therapist must create an environment where epistemic trust can develop and grow. That will ultimately be based on the therapist since the patient is a constant. Therefore therapist skills are more critical than the treatment technique, but nevertheless can we really know what is truly "evidence based" since we know so little about psychopathology? There is no such thing as "effective treatment technique" removed from an "effective therapist". An ineffective therapist applying an evidenced based technique will always be less effective than an effective therapist applying a technique that they are comfortable and skilled with regardless of its empirical basis. Great debate, what is beautiful is that we are all going forward together even when we disagree because, as Dr Wampold says, it will continue to evolve.
Maybe a shift in the identity of psychological research needs to happen, opening up the constraints of "we are a science" (the replication crisis has shown big problems), more focus on guidance, perspective or simply put help? Although health insurance might be less willing to pay for that
Thank you for posting this interesting conversation. I found myself feeling quite frustrated that in both speakers’ descriptions of what is needed in therapy and attitudes within the therapist, they were both describing the person-centred modality. There is certainly much research and work to be done within the PC field, but it is alarming to me that we’re describing the need for therapists to be empathic, open-minded and sensitive to the client’s individual needs, when this idea has been around in psychotherapy for 70+ years. I did enjoy the insight into implementing solutions at scale, and how IAPT works in England. I have experienced many anecdotal accounts of IAPT only being effective for clearly definable symptoms and disorders such as phobias, yet actually hindering less definable symptoms and disorders including anxiety and depression. I look forward to seeing further research on this in future.
Was that you got from it mostly I guess assuming that's only why you felt frustrated what I got from them was jus how procedures work with therapists In general like the cultural affect from a cultivated therapist helps or would jus help as much as a regular procedure bu not perfectly like what I got from that was jus how different every single therapist is not jus therapists need to be empathetic and more open minded they do bu only when and how their gonna proceed with their own research on their client I'm not saying that I'm jus wanting more open minded therapists not at all that's not my point only a fraction of it my point is from this I got that they don't know what works in therapy jus yet but they will find or try too like when a therapist pretends nods their heads they said that will absolutely never work or help in any way to me this entire thing was jus about what these professional jjus others bu these OTHER others the higher more experienced therapists they see or can call how bland treatments could go or sessions I mean the rest I got was jusbhow their gonna found out more different psycho therapy or analysis or behavioral therapy models can be created so yab
But they weren't just saying that what's missing are the person-centered conditions - they actually agreed on something that person-centered therapists totally reject, namely, the need for structure and a modality-based theory or explanation for what is causing the patient's distress and how it can change. Person-centered theorists - at least the more purist ones - argue that diagnosis, theory, structured interventions, etc, are actually harmful to patients and that all the therapist should be doing are the Rogerian "techniques" of empathic listening, reflecting feelings/meaning, and so on.
Whats to keep a therapist from easily figuring out how to pass it whatever "personality" they have? Whats to keep them from giving answers that will get them hired? Especially once they are trained in psychology.
I think this is possibly the most important of questions. @janedoe6704 raises another very good point, but I think we must ensure that therapist personality assessment must be in place, must be rigorous and must be regular (e.g. annually).
Challenge to veteran therapist is decline in identifying innovation or newness in the story of every client. Declined enthusiasm of veteran therapist can unconsciously affect the results negatively.
6:56 "New" therapies over the decades 16:30 Every explanation we currently have for a disorder will turn out to be wrong. 20:32 On average therapists get less effective as they gain experience. 21:19 What makes effective therapists 23:29 Why therapists get worse: Protypes and putting patients into categories, losing person-centered perspective. 37:57 We don't know very much about what makes psychotherapy. Quit funding comparisons between two treatments.
IAPT for children and adolescent are one huge massive failure, but they are so committed to it they can’t change course. It’s didactic psychoeducation and everyone it’s completely over evaluated constantly.
This is very disturbing. So ... the therapy industry doesn't know "what works", and we should study to see what therapists do to see who is effective, then teach what they do? Disturbing that therapists get paid to wing it -- whatever "it" is, and that the education industry doesn't teach therapists what they need to know., and that there are 1,246 therapies which have very little difference in efficacy rates. Hmmmm.
Reality is not disturbing. There is no one-size-fits-all approach. To try and implement one would be disastrous. Each person is unique and requires a different approach. Some therapists are better at getting to know the patient than others. You can't sciencify everything. Psychotherapy is more of an art than a science.
@@EmbraceTerror I understood it perfectly. You're complaining that therapist get paid to wing it, and that they don't have the education upfront to know how to deal with every possible situation that all of their patients maybe going through. And my argument is that there's no way to teach that. There is no one-size-fits-all solution. It takes time and experience in the trenches before you understand how to navigate the sensitive and unique situations that people find themselves in.
@@johncasey5044 Then alleged credentialed education is useless, and the industry should not release inexperienced "therapists" onto the unsuspecting clients who deserve genuine help not to pay to be a practitioner's unwitting guinea pig.
@@EmbraceTerror again, it's an art, not a science. Much of what makes a good therapist is innate and cannot be taught in the usual setting. I can agree that most therapists are not up to par, but I'd have to say the same about most of society (and their respective careers), so my argument would be a moot point. What therapists need are transparency and accountability. They need to be supervised forever. Lest they get carried away with their own inflation.
Consider using AI, on some level. They are more of standard quality when it comes to treatment procedures, at least better than the bottom 15% psychologists. And it will become cheaper and more affordable for everybody.
Genuineness, kindness, empathy, 'attunement', respect, compatibility You can't really study any of them, but surely they are the most important factors.
Great talk with lots of challenges to business as usual in psychotherapy. Thank you for making these talks available/
Although it seems strange that new therapies are developed every so often when therapies that work already exist, I've found in clinical practice that some therapies achieve better outcomes. I know this is not supported by empirical evidence but I certainly can't deny practice-based evidence. Perhaps it's because the therapist is more confident in, and buys more into, certain therapies and therefore come across more competent when delivering those approaches.
Yes, and also, possibly, that certain therapeutic approaches are more closely aligned with the skills and dispositions of different therapists.
"Evidenced Based the therapeutic Practice" is a misnomer, as I think Dr Wampold is saying. First we do not know what the actual mechanism of pathology is in the patients. We do not know this and we should not represent that we do, we cannot test for a psychiatric disease and demonstrate physically, empirically, that it exists, let alone WHAT exists. Since we don't know what is wrong, when someone experiences positive change, we don't really know what was changed, or how it changed, or why it changed. Therefore the only evidence we have is that THIS treatment seems to be effective in this way with this disorder to some level of confidence but that it is rare that one technique is truly superior.
Common Factors say the therapeutic alliance is a major factor in patient change/effective therapy. The therapist must create an environment where epistemic trust can develop and grow. That will ultimately be based on the therapist since the patient is a constant. Therefore therapist skills are more critical than the treatment technique, but nevertheless can we really know what is truly "evidence based" since we know so little about psychopathology? There is no such thing as "effective treatment technique" removed from an "effective therapist". An ineffective therapist applying an evidenced based technique will always be less effective than an effective therapist applying a technique that they are comfortable and skilled with regardless of its empirical basis.
Great debate, what is beautiful is that we are all going forward together even when we disagree because, as Dr Wampold says, it will continue to evolve.
The more we try to look for "mechanisms" in psychology, the more we flirt with physicalism, in which there is no real evidence for other minds.
Maybe a shift in the identity of psychological research needs to happen, opening up the constraints of "we are a science" (the replication crisis has shown big problems), more focus on guidance, perspective or simply put help? Although health insurance might be less willing to pay for that
@@johnwhorfin3815 Because "mind" is axiomatic and equivalent and consistent with physical information.
Fruitful discussion
I certainly enjoy listening to you guys so far and I'm only 19 mins in. Just wish I could be part of that debate. Just fascinating fellas 🕉
I really enjoyed listening to this, thanks for posting it!
thank you for sharing the debate.
Thank you for posting this interesting conversation. I found myself feeling quite frustrated that in both speakers’ descriptions of what is needed in therapy and attitudes within the therapist, they were both describing the person-centred modality. There is certainly much research and work to be done within the PC field, but it is alarming to me that we’re describing the need for therapists to be empathic, open-minded and sensitive to the client’s individual needs, when this idea has been around in psychotherapy for 70+ years.
I did enjoy the insight into implementing solutions at scale, and how IAPT works in England. I have experienced many anecdotal accounts of IAPT only being effective for clearly definable symptoms and disorders such as phobias, yet actually hindering less definable symptoms and disorders including anxiety and depression. I look forward to seeing further research on this in future.
Was that you got from it mostly I guess assuming that's only why you felt frustrated what I got from them was jus how procedures work with therapists In general like the cultural affect from a cultivated therapist helps or would jus help as much as a regular procedure bu not perfectly like what I got from that was jus how different every single therapist is not jus therapists need to be empathetic and more open minded they do bu only when and how their gonna proceed with their own research on their client I'm not saying that I'm jus wanting more open minded therapists not at all that's not my point only a fraction of it my point is from this I got that they don't know what works in therapy jus yet but they will find or try too like when a therapist pretends nods their heads they said that will absolutely never work or help in any way to me this entire thing was jus about what these professional jjus others bu these OTHER others the higher more experienced therapists they see or can call how bland treatments could go or sessions I mean the rest I got was jusbhow their gonna found out more different psycho therapy or analysis or behavioral therapy models can be created so yab
But they weren't just saying that what's missing are the person-centered conditions - they actually agreed on something that person-centered therapists totally reject, namely, the need for structure and a modality-based theory or explanation for what is causing the patient's distress and how it can change. Person-centered theorists - at least the more purist ones - argue that diagnosis, theory, structured interventions, etc, are actually harmful to patients and that all the therapist should be doing are the Rogerian "techniques" of empathic listening, reflecting feelings/meaning, and so on.
In my locality, peer supervision is a requirement of being registered with the board.
Thank you.
Do psychologists get a thorough personality test before they are allowed to see patients? If not, there should be one.
This!!!!
Whats to keep a therapist from easily figuring out how to pass it whatever "personality" they have? Whats to keep them from giving answers that will get them hired? Especially once they are trained in psychology.
REGULARLY ASSESSED, ON ALL POINTS
I think this is possibly the most important of questions.
@janedoe6704 raises another very good point, but I think we must ensure that therapist personality assessment must be in place, must be rigorous and must be regular (e.g. annually).
At least give a simple test for psychopathy.😂😅😢😮
Awesome video!
Challenge to veteran therapist is decline in identifying innovation or newness in the story of every client.
Declined enthusiasm of veteran therapist can unconsciously affect the results negatively.
Any therapy proves to be of advantageous if therapeutic intervention "empowers" client to utilize learned measures in social and personal life.
🙏🙏🙏
What does PF mean by "mental disorder"?
Psychopathology 39:25
....special guest: anders breivik...........
excelente
6:56 "New" therapies over the decades
16:30 Every explanation we currently have for a disorder will turn out to be wrong.
20:32 On average therapists get less effective as they gain experience.
21:19 What makes effective therapists
23:29 Why therapists get worse: Protypes and putting patients into categories, losing person-centered perspective.
37:57 We don't know very much about what makes psychotherapy. Quit funding comparisons between two treatments.
22:26
IAPT for children and adolescent are one huge massive failure, but they are so committed to it they can’t change course.
It’s didactic psychoeducation and everyone it’s completely over evaluated constantly.
This is very disturbing. So ... the therapy industry doesn't know "what works", and we should study to see what therapists do to see who is effective, then teach what they do? Disturbing that therapists get paid to wing it -- whatever "it" is, and that the education industry doesn't teach therapists what they need to know., and that there are 1,246 therapies which have very little difference in efficacy rates. Hmmmm.
Reality is not disturbing. There is no one-size-fits-all approach. To try and implement one would be disastrous. Each person is unique and requires a different approach. Some therapists are better at getting to know the patient than others. You can't sciencify everything. Psychotherapy is more of an art than a science.
@@johncasey5044 It appears you missed my point. I'm okay with that.
@@EmbraceTerror
I understood it perfectly. You're complaining that therapist get paid to wing it, and that they don't have the education upfront to know how to deal with every possible situation that all of their patients maybe going through. And my argument is that there's no way to teach that. There is no one-size-fits-all solution. It takes time and experience in the trenches before you understand how to navigate the sensitive and unique situations that people find themselves in.
@@johncasey5044 Then alleged credentialed education is useless, and the industry should not release inexperienced "therapists" onto the unsuspecting clients who deserve genuine help not to pay to be a practitioner's unwitting guinea pig.
@@EmbraceTerror again, it's an art, not a science. Much of what makes a good therapist is innate and cannot be taught in the usual setting. I can agree that most therapists are not up to par, but I'd have to say the same about most of society (and their respective careers), so my argument would be a moot point. What therapists need are transparency and accountability. They need to be supervised forever. Lest they get carried away with their own inflation.
Consider using AI, on some level. They are more of standard quality when it comes to treatment procedures, at least better than the bottom 15% psychologists. And it will become cheaper and more affordable for everybody.