If a placebo works generally then it works. Isn't all psychotherapy in a way just a placebo?
Absolutely not.
It is one thing to just give someone a sugar pill or a random ritual and tell them "this will make you feel better". That's placebo. (Not saying it never works, just that's the definition of placebo.)
It is another thing completely to help people realize which thought patterns and which conscious focus and which memories keep them stuck in old loops. Which subconscious patterns and habits make them miserable. Which parts of their current world model are not working for them and help them actually transform the way they think about themselves, view themselves, feel themselves, the way they operate in the world on a day-to-day basis. That's psychotherapy. It is literally changing the software of the human mind.
Now there might be fake psychotherapists out there who don't know what they are doing and are limited to the effects of placebo in their practices. But that does not mean that one thing is the same as the other.
I can also see how there could be cases where a person receives a placebo, for some reason (the magic behind placebo) it makes them feel exceptionally well, and they use this push of energy to transform some part of their worldview on their own and so they keep some long-term effects of it. This doesn't either make one thing the same as the other, and it does not happen so often either.
Though you have to be careful how you define your placebo.
One approach would be a sugar pill. But the patient would know that this is not psychotherapy. So it doesn't work as a proper placebo.
A slightly better example is a heartwarming chat with a high status individual who is not schooled in any psychotherapy. Say a random professor.
What can be said for sure, and which was my original point, is that regardless of which one is "better", they are not the same thing at all. They are two very different distinct concepts that describe two very different existing phenomena.
Incidentally, it is very clear to me, based on my life experience (and that includes using critical thinking to approach life) and experience of many other people I've met that in most cases real psychotherapy is quite effective, unlike most uses of placebo. Although there seem to be cases of placebo that are exceptionally effective too, so who knows?
This is of course just an anecdote and I don't have any studies at my fingertips right now that somehow calculate and compare the relative effectiveness of the two. I would imagine that using and especially scaling placebo in effective manner is difficult because it relies on active ignorance of the user.
So when I mentioned talking to some random high status individual who lends a sympathetic ear, that's one way to separate the factors.
Another one, with lots of practitioners, is looking at pastors and other religious figures. Pastoral care is a big deal. Whether you want to treat that as placebo or a special kind of psychotherapy is a judgement call.
If these examples work just as well (or badly) as Freudian psychoanalysis, then that's good knowledge to build on.
Perhaps they work better or worse than Freudian psychoanalysis. That's also useful to know.
See https://slatestarcodex.com/2019/11/20/book-review-all-therap... for how basically every kind of therapy can claim lots of life experience and critical thinking evidence in its favour.
If you read deeper in the page you linked on the subject, it goes on to the actual conclusion that the common factors of psychotherapy - empathy, positive regard, strategic alliance, and others - are predictive of psychotherapeutic outcome across therapies. In addition, it is shown that many key features of modern psychotherapies including awareness of one's thoughts and emotions are essentially universal therapeutic components.
In the book on the subject by Wampold and Imel, they found real and significant difference between therapists on their ability to produce outcome based on these common factors. So while modern therapeutic models may be indistinguishable in terms of outcome, modern therapists are not. And there IS such a thing as better vs worse therapy. And this is an ongoing research area.
To be more explicit: it's a bit of an issue of definition.
I was going by the rule of thumb that whatever your homeopath or acupuncturists would also do, would count as placebo from the point of view of psychotherapy.
And, yes, those people employ many of the same common factors. And different people have different amount of skills in employing those. (Or creating different outcomes in general.)
If you want to call that placebo or not, is up to you.
There's also very interesting research into what makes effective placebos, and how eg cultural context influences that.
From what I've read (sham) surgery is more effective than an injection which is more effective than a pill. And more expensive placebos are more effective than cheaper ones.
If memory serves right, whether big or small pills have a bigger effect depended on country. (The hypothesis was that some cultures believed smaller pills are more highly concentrated, whereas others believed bigger is better.)
And, it's getting stronger over time, oddly enough. https://www.wired.com/2009/08/ff-placebo-effect/
>The body’s capacity to heal itself after receiving only the simulated experience of medication or therapy is well documented. But precisely because that capacity is so well documented, reflexive dismissal of the placebo effect as “fake medicine” demands scrutiny—and is now receiving it. In late 2018, The New York Times Magazine reported on a group of scientists whose research suggests that responsiveness to placebos, rather than a mere trick of the mind, can be traced to a complex series of measurable physiological reactions in the body; certain genetic makeups in patients even correlate with greater placebo response.
TLDR: Please do not use placebo effect as a catch all term and as a pretext for not scrutinizing the experiences of millions of patients.
As most of us on hacker news have a very scientific attitude towards life, we can atleast experiment with it. If it works for us, then good. If it doesn't, we can move ahead.
Spending an hour a week with someone patiently listening without judgement while I tell them everything that's been going on in my head. And sure enough, my emotional problems start to recede and I start to be more engaged with life, less depressed, and more able to function.
I don't know if I'd call that placebo, though. I used to thing it was magic; I talk, and my problems vanish. Looking back on it, it was obvious. Almost exactly like explaining to a rubber duck about a coding problem and seeing the answer suddenly. Having another human patiently listen without judgement to all the crap in my head - that's powerful. Even more so when they then hear the worst stuff that we could ever possibly admit to anyone, and gently confirm that this is normal.
Maybe Reiki is "just" someone touching you gently while wishing you would get well. Again I'm not sure I'd call that placebo.
There's something messed up about our cultures that allows these things to work.
I also have a hard time rectifying the idea that you can pay someone to listen to you, and at the same time try and hold the belief they really care about and like you. If they care, why are they accepting money just to listen to you? To accept the premise of psychotherapy, and what they tell you in sessions, namely that they do care, it seems you need to achieve a suspension of disbelief that I never could.
I've always wondered what sort of damage that could do to you psychologically, holding that belief for a long period of time. I mean, the person who you place the most trust in, who knows you best, is also charging you an arm and a leg every week. You paid for their summer home.
Because they have to pay for food, pay for a roof over their head and pay down their student loan?
Accepting payment does not mean they will care, but it certainly does not preclude that they may care.
I'm not sure this is ever a pre-requisite; this expectation might cause you to distrust the very thing that might help you. A therapist is a guide, not a friend. I have to dig up the studies (or feel free to google), but it's been shown that just going through a script produces measurable benefits on aggregate, regardless of the therapists' shortcomings. There's an analogy to physiotherapy. In physio, you're doing the work under a coach's care -- doesn't matter how you feel about the coach as long as the prescribed techniques are correct. Results will come.
Depending on your situation, you can even do CBT on yourself and see measurable benefits (Mind over Mood by Greenberger/Padesky is the usual recommendation; however YMMV -- not all pathologies respond to CBT). Not to say that there isn't a benefit to a truly empathetic therapist (there is -- you need someone you feel comfortable opening up to), but a suspension of disbelief seems to me to not be necessary. (source: personal experience)
My therapist was fantastic. I wouldn't say she cared about me, but she definitely cared about her craft. She wanted the best for me, partly because that is what motivates her to do this.
Almost exactly like seeing any other health professional. My doctor doesn't "care about me". They care about being a good doctor, and helping me recover from whatever ailment I have is what good doctors do.
I'm not a mental health professional, but it sounds like you needed your therapist to "care about you" in order to accept their help, which is something you might want to talk to them about.
Astrologists and homeopaths might be equally effective in these cases.
As such, this is clearly not placebo. But I find it sad that what could be a normal part of everyone's life (taking to people who care about you) is being presented as a medical intervention.
Also, I find the timing of the article odd. Exactly now that hospitals are overwhelmed they propose treatments that require even more staff time.
Others have said it better than I'm going to here, but please disabuse yourself of this notion.