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However you'd find also thousands, millions in fact, of happy people who used the services of psychics, mediums, astrologers, crystal healers, taro readers, shamans, reiki practitioners, remote viewers. You'd also find millions who got cured with sugar placebo pills.

Which is not to say psychotherapists don't do anything right. Maybe they do something right. But it may be almost by accident, or maybe much is not needed for you to feel someone's got your back.

These trends, of solving a given problem a given way, are largely cultural. I wouldn't be surprised if one day we see present day psychotherapy as flawed as we see alchemy today.

I do not believe it is the case that you could find thousands, let alone millions, of people who have been cured of acute mental health ailments by means of astrology, crystal healing, or remote viewing. Further: your argument boils down to "there are sham cures, therefore all interventions are apt to be sham cures".

His argument sounds more to me like, "There are sham cures that have worked. Therefore this other thing that might work isn't conclusively not a sham."

People with "acute mental ailments" are treated by psychologists not psychotherapists (not the same at all), and are often put on debilitating drugs for the rest of their lives, not "cured". Never heard of people "cured" of schizophrenia or bipolar disorder etc. by psychotherapy.

Also, my argument doesn't "boil down" how you present it, you're severely misrepresenting what I said. The point is just because some people think it has helped them, doesn't mean it did. We're trying to attribute cause to effect, but we're often wrong about it. Our brain works by association, and associations are commonly misattributed.

This is why studying the field scientifically is important, rather than relying on "proof by testimonial". Especially the testimonials of fragile, suggestible people who would look for someone to lean on and trust by the very definition of their conditions.

And I meant psychiatrists up there, which is yet another thing. Sigh.

Psychiatrists often deliver therapy in some kind of modality, and refer out to therapists for other modalities. It's like the distinction between your primary care physician and a radiologist. They're distinct practices, but it's not like they're somehow adversarial.

I didn't say they're adversarial. The fact they neatly fill a gradient of niches, doesn't mean they're equally well supported scientifically, and equally useful.

There are still places where your doctor would send you to the local homeopath. Doesn't make homeopathy science. Or to the local priest to get exorcised. Doesn't make exorcism science. It simply makes them culturally accepted.

Cultural acceptance and science are not the same thing. Although often confused.

I don't know of any place in the US where a doctor would refer you to a homeopath. But virtually every doctor in the country would refer you to a psychiatrist, or directly to a therapist (one common way of providing mental health services is for PCPs to prescribe antidepressants and refer out for therapy), and virtually every psychiatrist would refer out to a therapist if they themselves didn't already provide compatible therapy modalities.

So no, I don't think this is a good comparison at all.

In Germany for example, homeopathy is covered by their healthcare insurance. I don't know why "in the US" is an argument. Space outside the US exists, and time outside 2023 also exists, and both those points in spacetime inform us about the culture we create as a species.

Just few decades ago you'd be referred for lobotomy in the US if you had... "unrest" I suppose. Or how about getting a red hot rod in the ear? Official cure for headache. But suddenly, here and now, we know everything, and nothing of anything we believe can possibly be false. It's always the same fallacy.

One has to be skeptical of everything, unless there are hard facts. Unfortunately psychotherapy is not hard science, by which I mean most of it doesn't lay in discovery following the scientific method in a rigorous, reproducible way.

In fact, the biggest component of the so called "replication crisis" comes from social studies, psychotherapy and psychology. It's full of papers proving "whatever" about human behavior.

> In Germany for example, homeopathy is covered by their healthcare insurance.

That's not true. Homeopathy in Germany is not part of official coverage. There are some select healthcare providers that refund some homeopathy costs, up to a few hundred euros annually, but the overwhelming majority does not even do that.

Sources on official policy and debates whether there should be reimbursements for homeopathy (the prior being: there are):

https://www.iamexpat.de/expat-info/german-expat-news/german-...

https://undark.org/2020/03/16/homeopathy-globuli-germany/

https://www.dw.com/en/german-health-insurers-urged-to-end-ho...

ECT is most definitely on the menu in 2023 around here, and I've discussed it with a few victims, I mean patients, who believe it's the answer to their prayers, and they must have their monthly zapping, or they just don't feel right.

> People with "acute mental ailments" are treated by psychologists not psychotherapists (not the same at all), and are often put on debilitating drugs for the rest of their lives, not "cured".

A prominent counter example to this is the treatment of PTSD.

> Further: your argument boils down to "there are sham cures, therefore all interventions are apt to be sham cures".

It absolutely does not. The GP dismissed the usefulness of studies and posited that personal anecdotes were sufficient.

If you think people haven’t or can’t be cured by astrology, psychics, shamanism, etc, I think you fundamentally misunderstand psychotherapy. The modern, clinical practice is just a controlled refinement of a process that has worked for thousands of years in thousands of ways. At an abstract level, it doesn’t matter what the method is, be it psychotherapy, astrology, psilocybin, etc. The benefit is in processing your thoughts to make sense of, and peace with, the world and the traumas it has inflicted on you.

> However you'd find also thousands, millions in fact, of happy people who used the services of psychics, mediums, astrologers, crystal healers, taro readers, shamans, reiki practitioners, remote viewers.

Maybe, and I know this seems like a crazy idea, we should look into that? It seems like a pretty big blindspot to dismiss all of that outright because the mechanism of action isn't yet understood or because it clashes with philosophical views that were common among some academics who died last century.

I don't think we dismiss that, but we attribute to the placebo (and nocebo) effect that is very real and still very poorly understood in spite of major efforts in the area. We know it exists, we know the factors that influence it, we know we can't really control it, but we don't understand the mechanism of action.

I suspect you could get the same benefit by paying some random nice person to talk with you for an hour about anything. Whether the topic is your star chart or home decorating or model railroads probably doesn't matter. There is a lot of evidence that frequent social contacts produce better mental health outcomes.

but you don't find random nice people. most people do not have the capacity or are not willing to empathize with the problems of others. especially as a man you are often not allowed to show vulnerability. these paid professionals are sometimes the only ones willing to listen and not laugh at your problems.

Yes, but being a psychotherapist is extremely emotionally taxing, which is part of the reason why it exists as a profession; try listening for a day straight of conversations regarding rape, sexual abuse, depression, anxiety, etc.

I wasn't referring to real licensed psychotherapists. My point was that if people feel like they benefit from talking to an astrologer then they could get the same benefit from talking to anyone else who's trying to help. The benefit comes from the social connection, not from the astrology.

These are all effective modalities in the right contexts. If you don't adopt a materialist metaphysics, it's easier to understand them, but it takes some time, effort and faith to gain access to the insight necessary to do that. Reiki is particularly easy to understand if you have a meditation practice—it's basically guided Vipassana from that perspective.

Another version that doesn't require endorsing esoteric practices is just acknowledging the effects of confession and things like faith healing, the "born again" phenomenon, etc. Here you see people reaching sustained ecstatic states through entirely mainstream Western practices.

Regardless, research does seem to show that methodology contributes very little to the effectiveness of therapeutic intervention. This is basically true in my experience. The most effective therapists have cultivated a certain quality of presence. If you want to look at it in a materialist frame, you could say they have a calm nervous system, which allows the clients nervous system to entrain to calmness and reinterpret challenging psychological material in an environment of held safety, similar to being held by a securely attached mother as a child.

Little about healing will be truly understood at the 'New York Times pop psych article level' of understanding until Western psychology fully integrates the insights of the great wisdom traditions, psychedelic medicine traditions, etc. This is currently happening very quickly and most advanced practitioners in the wild are well past the Overton Window.

Only one of the treatments you described has been subject to evidence-based approaches using the scientific method.

> I don't need studies to validate the hundreds of incredible results I've seen

<sigh>

> I don't need studies to validate the hundreds of incredible results I've seen within the population I have direct access to (and myself)

One would hope that most HN crowd would hopefully stop reading after this sentence.

Where to even start?

> Where to even start?

Maybe reading the rest of the comment is a good start

> Maybe reading the rest of the comment is a good start

The rest of it the comment is discredited by the line I quoted.

It already contains two biases verbatim. So that without even considering those that can be deduced/assumed further it can't be taken seriously.

Replace 'psychotherapy' with 'astrology' and reconsider OP's sentence:

"I don't need studies to validate the hundreds of incredible results I've seen within the population I have direct access to (and myself)"

Mind you, I am talking about the comment here. My opinion about the article the discussion is about is a tad more nuanced but that is beside the point of my reply.

> I don't need studies to validate the hundreds of incredible results I've seen within the population I have direct access to

We certainly wouldn’t want data to get in the way of our confirmation bias.

A more accurate representation of the conservative position is that they just don't want to be forced to pay for psychotherapy for others, especially since there is very limited evidence that it actually works better than other treatments for certain conditions. I haven't seen any principled conservatives object to other people paying out of pocket for their own psychotherapy, even if they consider it ineffective.

Who are you addressing here? It certainly isn’t the comment you replied to.

I can conceive of a whole gamut of therapies which I'd rather not be funding with my tax dollars or insurance premiums, but my list is distinct from yours, and it would seem fairly individualized.

So it seems like the best solution is emerging: there are Christian Health Sharing ministries which impose requirements on the morals and faith practices of their members, and they also disallow sharing of costs for treatments which contradict or deny Christian doctrine, as delineated by the ministry's guidelines.

So, people are free to associate with a health sharing plan that is not insurance, and promises to observe the tenets of shared beliefs (Christian or not). It works more like a mutual benefit society.

In fact, there are a significant number of psychotherapists and other practitioners (natural medicine too) who do not accept any form of insurance. The health sharing ministries work with their patients to pay the bills.