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Philosophy of Therapy 2020-10-10T20:12:38.204Z · score: 91 (48 votes)

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Comment by daystareld on Philosophy of Therapy · 2020-10-16T06:24:39.746Z · score: 6 (5 votes) · LW · GW

Pretty good :) My versions just kept tweaking what you already wrote, except for Systemic, to which I would also add "and how you affect that system." A lot of systemic therapies explore not just how the system might be perpetuating the pathology, but how the client's behavior also maintains that system, such that it perpetuates the pathology, recursively.

Comment by daystareld on Philosophy of Therapy · 2020-10-16T05:47:54.212Z · score: 3 (2 votes) · LW · GW

Yeah, I had (have?) high skepticism of its effectiveness too, and it's definitely not a modality I'd use myself, but then I remember that I have used board games in therapy before with younger clients, particularly families, and there's some surprising stuff that can come out by observing the way people play games :)

Comment by daystareld on Philosophy of Therapy · 2020-10-16T05:41:45.215Z · score: 6 (4 votes) · LW · GW

For one thing, the Dodo bird verdict is (maybe not surprisingly, given point 3) not as well supported as people widely think. It originated decades ago, and may have set in motion the very effects that led to its own eventual lack of relevance. The study I linked to in the OP, if correct, points to just such an invalidation by presenting findings that a particular modality works better for a certain type of treatment than alternatives.

But if we take it at face value, the answer could just come down to "the human element." Maybe good therapists are what matter and the modality, as long as it's not utterly bankrupt, is just a vehicle. Personally I don't believe that's the full story, but a good relationship with the therapist does seem more important than anything else, and that factor being mostly independent from what modality the therapist uses may account for a large part of it.

Ultimately though, I think part of what my post is tries to do is point out that these different philosophies don't necessarily contradict each other, but rather are different lenses through which to view the problems the client has. When I get a client that responds super well to CBT, and then another client who doesn't but grabs IFS and runs with it, I don't think "well I guess these modalities are equally effective" or think that some kind of paradox is occurring, I just think that different maps are better for different people at navigating the territory, even if they're dealing with the same "problem."

I know it feels a bit like a cop-out, but honestly given how complex people are, and how different each problem can be even if it shares the same diagnosis, I would be pretty shocked if a single modality just blew all the others out of the water for every kind of problem that someone might face. Which isn't to say that they're all the same, either, just that guidelines for good therapy have to include more than just singling out specific modalities, but also identifying which ones might work best with each client.

Comment by daystareld on Philosophy of Therapy · 2020-10-13T08:25:37.492Z · score: 3 (2 votes) · LW · GW

Yes, I think a big part of what ends up happening when people have bad experiences with therapy is that they imagine that the therapist they had, or the type of therapy that therapist practiced, is representative of all therapy. This may actually be true in some parts of the world, but in countries like the US there is a huge variety in both modalities and therapeutic "personalities" so to speak.

Comment by daystareld on Philosophy of Therapy · 2020-10-12T08:57:59.634Z · score: 3 (3 votes) · LW · GW

Since there's currently no academic field of study on therapy as a whole, I would argue that the contents of the post would be a reasonable starting point in forming one, or at least that it covers a lot of the same material (what therapy strives to do, what the base assumptions are, the various different theories of change that different therapy schools hold, setting out a system of classifying modalities, etc). I don't think the post meets the rigor for a published paper, and such an academic field ideally would be focusing on studying effectiveness of each philosophy/modality, but it's not unrelated to what I imagine a hypothetical Philosophy of Therapy field to focus its attention on.

If you disagree, could you say a bit more about what you would expect such a post using the name in that context to contain?

Comment by daystareld on Philosophy of Therapy · 2020-10-11T20:20:16.849Z · score: 2 (2 votes) · LW · GW

Yep, that was a great thread.

Comment by daystareld on Philosophy of Therapy · 2020-10-11T20:18:44.267Z · score: 11 (8 votes) · LW · GW

Let me start by saying that I definitely don't recommend people go to therapy anymore unless I can also offer them guidance (like with this post) in what to expect or how to spot a good therapist or what kinds of modalities are effective. There are just too many bad therapists out there. But I think your comment may be too confident in the wrong direction.

>I think people should know that when it's been studied, there's little evidence that talk therapy works better than getting support from a friend, family member, or other trusted person. 

Would love to read a source for this, if you could point me to which study you're referring to. To me the most interesting studies on therapeutic effectiveness focus on a particular modality, like the one I linked to in the post, whereas "therapy" as a whole is such a mixed grab-bag of different philosophies and ideas that as a generic practice, I'm definitely willing to believe that most people's experience with it has not been particularly effective. But that doesn't mean an "informed shopper" with a good guide can't beat the odds.

>But anytime a person invests substantial time and money into a given strategy, there is a risk that their assessment of the results of that strategy will be affected by confirmation bias, sunk cost bias, and cognitive dissonance. 

Interestingly, my experience is the opposite; people are very quick to point out when therapy didn't work for them, particularly if they feel like they wasted a lot of time and money at it. I don't generally see a lot of people singing the praise of therapy unless they had an outstandingly good experience with it. 

>Experiment for yourself, by all means, but my experience has been that a very brief conversation, coming at the right moment, can be incredibly therapeutic. Or an in-depth conversation every few months. Or support from a friend along with all the other self-help strategies that commonly work for mental/emotional problems. 

Absolutely true, for the majority of situations people are troubled by. As I said in the post, I think therapy is best meant for when nothing else seems to work, including talking to friends and family.

>If you tried therapy, you would see how great it is. Therefore, you must not have tried it, so I will dismiss your opinion.

This is indeed a dumb argument, and I'm sorry that you've been told that. Like I said, I've often heard the opposite; people with bad experiences with therapy are more likely to speak out about their bad experiences, in general, and most get sympathy for expressing how therapy didn't work for them. I can imagine people trying to suggest that THEIR experience with therapy was particularly good and so if you just tried the modality they experienced maybe you'd change your mind, but practitioner skill also makes a huge difference, and the relationship with the practitioner is always a wildcard, so people should generally be a lot less confident when recommending therapy to others.

That's a large part of why I made this post; to help people get some benefit from therapeutic philosophies without having to necessarily go to a therapist themelves.

Comment by daystareld on Philosophy of Therapy · 2020-10-11T20:06:50.885Z · score: 1 (1 votes) · LW · GW

Glad to hear it!

Yeah, I know the title is a bit vague, but Modalities are pretty specific and only like 1/3 of the post if that focuses on them. I've thought of alternative titles, like "Change the Frame, Change the Problem," but that's pretty vague too, and nothing feels like it fits better.

Comment by daystareld on Building up to an Internal Family Systems model · 2019-10-13T21:03:07.483Z · score: 6 (3 votes) · LW · GW

I will note that, in my own practice, IFS and subagents are never presented as "separate from you," but rather "parts of you." What you're describing sound more like what Narrative Therapy sometimes does, in externalizing and personifying the Anger or Addiction or whatever, and then working to better understand its influences on you and your ability to influence it and so on, though the framing on that can also vary greatly between one practitioner and another.

Insofar as some people use IFS to "other" their internal desires or behaviors, this feels like it's naturally determined by the "client" more than anything. Some people just find the idea of breaking themselves down into sub-agents or "child vs teenage vs adult self" really clicks with the way they relate to their competing desires and goals, without quite giving up "responsibility" for them... but that opens up a new conversation about how important the sense of "responsibility" for our flaws actually is toward addressing them, which also probably depends a lot on how motivated the client is toward change.

Comment by daystareld on Heads I Win, Tails?—Never Heard of Her; Or, Selective Reporting and the Tragedy of the Green Rationalists · 2019-09-25T04:12:50.840Z · score: 20 (8 votes) · LW · GW

Great post. Something that's worth noting is that this is true *even if reality is not 1:1:1.*

Let's say the joke "reality has a well known Green bias" is actually true, and add an extra Green side to that impossible die and make it a true four sided pyramid, easy to picture and shake in your hands. It's now 2:1:1 Green:Blue:Grey

Reality says "Roll 10d4," and you let all the little pointy shapes in your palms spill out to reveal... *rolls actual dice* ~4 Green, ~4 Grey, and ~2 Blue.

"Oh snap," you, a Green, might say. "Evidence that my philosophy/political views are correct!... Er, I mean, more correct than the local alternative competing one! And really, that's what matters, isn't it? No one's PERFECT, but at least we can feel justified in fighting the good fight!"

You still have two glaring problems.

1) You're still, in the majority of cases, wrong, on this particular subject/roll. This is an unpopular thing to say among Greens. "We're actually wrong on most things, but we're more right than the opposition!" is only ever going to be a rallying cry for those who intrinsically dislike tribalism and grok lesser-of-two-evils and advocate for slow and steady progress, not those trying to Win The Battle for the Soul/Future/Rights of the Whatever.

2) Your opponents are actually still right on half the things they're fighting for compared to the things you're right about. Even hinting at this will make you EVEN MORE UNPOPULAR among your fellow Greens. Especially if any of the things they're right about are particularly hot-button issues at the point in spacetime that you find yourself in.

So, being a Green (or a Grey who knows that Greys have no chance and so hesitantly puts on a Green uniform) who now wants to actually go into politics and push for positive change, you will by necessity feel a lot more inclined to focus on those 4 things that you have strong evidence your side is right about, ignore those 2 things that your opponent is right about (unless you're behind closed doors with similarly reasonable Greens, Blues, or Greys), and maybe once in awhile try to push at a couple of the 4 things that both sides are wrong about, assuming you have any political capital to spare (you probably don't, hell you probably don't even have enough to focus on all of the 4 dice-backed Green topics).

Well guess what: now to an "objective observer," you, an intelligent and competent politician, look like a biased ideologue who's blinded by his partisanship and just appealing to his rank-and-file.

Change this from 10 separate issues to 10 pieces of evidence that make up the nuance of a single issue, and a similar thing happens as nuance gets left at the wayside. Now imagine that not everyone is actually researching all those dice rolls and instead just randomly looking at the subsection of them that happen across their newsfeed, or which appeal to their particular interests, or are the least complicated to take in.

It's disheartening, but it can help to note that those who are trying to actually make changes in any social sphere are not working under the same rules/toward the same goals as those trying to just seek truth. This is not a defense of lying, by omission or otherwise, but it is a defense of people who have good reasons to do or say things that we, observing them from the outside, may think are evidence of them being mindkilled.

Comment by daystareld on An Ontology of Systemic Failures: Dragons, Bullshit Mountain, and the Cloud of Doom · 2018-09-09T22:37:23.685Z · score: 1 (1 votes) · LW · GW

Ah, maybe. I was under the impression that CoDs are the emergent properties of multiple Dragons or BSMs interacting, and their main feature seemed to me that they are the thing that "gums up the works" and makes it harder for people in a system that's trying to solve problems to actually do so.

Comment by daystareld on An Ontology of Systemic Failures: Dragons, Bullshit Mountain, and the Cloud of Doom · 2018-09-08T20:02:00.079Z · score: 18 (10 votes) · LW · GW

I don't know how well the things I've been thinking about lately fit into this model, so I'm going to attempt to apply these to my own field (Youth Emergency Services for suicide/homicide/psychosis):

1) Bug is when a clinician gets a call about a crisis and fails to triage whether it's an issue of sufficient severity. Mom calling because she took her kid's phone away and now they're yelling and won't go to bed can probably be de-escalated over the phone, even if they said the magic words of "I'm going to kill myself," as long as they don't have a history of depression or suicidal ideation or self-harm. Simple fix is to train people to better triage and how to respond/deescalate remotely.

2) Dragon is kind of what the job was designed to deal with. Before mobile response teams existed for mental health workers, and in counties that don't have them, people just call the police. The police will either sit the person down to give them a stern talking to, or arrest them, or take them to the nearest hospital's psych ward, depending on what's happening. Someone decided "Hey what if we sent therapists instead, who could de-escalate the problem instead and reserve the involuntary commitment for the cases that really warrant it?" Problem is it's not really a "solvable" problem, which means...

3) Bullshit Mountain is sort of the job itself? There's no Win Condition, it's just an ongoing series of getting crisis calls and helping those involved as best we can, whether that's teaching coping skills, creating safety plans, connecting them to services, or sometimes initiating a Baker Act (Florida protocol for involuntary 1-3 day stay at psych ward). Some people only call us once and everything's fine in follow-up calls. Others call multiple times per month, sometimes even per week, and have been Baker Acted by us or police over a dozen times. But stats say the county is overall doing better for youth suicides/homicides and hospital psych wards have fewer kids being brought in, all this even with things like the Parkland shooting, so we keep plugging at it.

4) Cloud of Doom seems like it could be at least a couple things. The first that no one wants to be left holding the Liability Hot Potato for a suicide, let alone the next mass school shooter, so we have police departments and schools calling us if any kid says anything even remotely like "I want to kill my geometry teacher," even if it was two weeks ago in a text message to their girlfriend, and then getting mad at us when we won't Baker Act them.

Which leads to some Molochian bullshit, where organizations start to *set protocols* to call us for anything that seems remotely worrisome, and then *our protocols* say that we can't be the ones to define a crisis for the caller, and so we get the occasional hilariously-frustrating call where a juvenile probation officer or school administrator calls us and says "They did/said X Y and Z, so do you need to make an assessment?" to which we have to reply "Well, if you say you want an assessment we'll be right over," to which they reply "Well they did X Y and Z," to which we will reply "Yes, I understand, does that mean you want us to come assess?" to which they reply "Do you feel they need an assessment?" Either we decide what's worth a crisis and liability falls on us, or the caller decides and liability falls on them.

You know where this is going: we're getting a steadily increasing amount of calls, and our ability to triage them is being slowly but surely hemmed in by expectations from on-high.

The result being a second Cloud of Doom, where the YES team (and I imagine other mobile crisis teams in other counties) have tons of communal responsibility but no actual institutional power. Which is often demoralizing and makes it hard to retain staff. Which means we're more often in situations where all our clinicians are busy out on calls, some of which we didn't really need to go on, but more keep coming in and we have to tell them to either take their kids to the hospital themselves or call the police if they believe it's an immediate crisis. Which was kind of what the job was originally designed to prevent from happening.

Does this seem to fit, or am I missing the essence of some of these?

Comment by daystareld on Affordance Widths · 2018-05-11T04:07:56.733Z · score: 9 (3 votes) · LW · GW

Unprimed audience is a huge part of this, as ialdbaoth says, and that experiment was also very different in setting than an office environment, for example.

Comment by DaystarEld on [deleted post] 2017-05-27T01:13:48.625Z

Cool. Do you plan on tracking each member's progress? Maybe a file for each member, with a score for "physical capacity, introspection, planning and execution skill," etc? Or are you planning on keeping things less concrete than that?

Comment by DaystarEld on [deleted post] 2017-05-26T04:30:33.479Z

I wanted to comment in order to, at the very least, publicly say that I love pretty much everything about this, and am crossing both fingers for its resounding success, both for the good it will do and the lessons we can all learn from it even if its success ends up looking different from how it's currently envisioned.

The main point of potential limitation that you acknowledge is that the time investment and rigid scheduling leaves a lot of people out of luck: either because their job is not a standard 9-5 that would allow for predictable morning or evening availability, or due to people having their own projects to work on. This can be seen as a plus, of course, since the house is going to be committing to long term and serious group projects, which is more beneficial in both directions for those who aren't currently committed to other endeavors.

So I will be interested in seeing how things adapt if someone in the house, for example, levels up a bit, finds a new job that changes their ability to commit to house requirements, or discovers or commits to a desire to create, say, a long running series of blog posts/videos/web serial/etc, but at the potential sacrifice of group projects, if not house-wide projects.

The ideal outcome in such a case might be, if possible, "wait until the current year is up then find a replacement and go do my own thing." Since people are likely to grow attached to the people and living situation of such a tight-knit "army," however, there's going to be some internal friction and conflict for many.

This ties into the larger idea, which I love, of "individual leveling up and sending superhero graduates out into the world to do lots and lots of exploring and tackle a wide number of strategies." I don't know how a "graduate" would be determined, other than potentially just by the person themselves.

Do you forsee yourself basically having a sitdown with one of your Dragons in a year or so and saying, "Hey X, I think you've grown a lot in your time with us, I'm so happy you were part of this, and I think we're hitting some pretty strong diminishing returns on what we can teach you going forward. Meanwhile I've got about a hundred people banging on the door to join us, but no room for them. You have three months to think seriously about what you're going to do next, and then we'll help you find a new place to live, preferably nearby if you want to stay close?"