15 Comments
User's avatar
Kyle Shepard's avatar

Very cool you considered being a clinical psychologist but ended up doing something different that’s helping millions of people in a different way. I also started out on a psych path but ended up pivoting to audiology and eventually a resilience instructor in the military. The psych foundation has stayed with me though and influences everything I do.

Great stuff as always

Expand full comment
Steve Stewart-Williams's avatar

Interesting! And thanks, Kyle - I appreciate the kind words!

Expand full comment
LV's avatar

Very cool. I have been a therapy skeptic and am happy to be proven wrong. Anecdotally, it does seem however, that a good fraction of patients don’t have a specific condition that they’re trying to address, as opposed to some miscellaneous personal problems. I wonder what therapy does for them.

Expand full comment
Steve Stewart-Williams's avatar

It’s an interesting question. I’m hoping to do a deep-dive into this topic at some point in the future. Stay tuned!

Expand full comment
JonnyB's avatar

Interesting article, thank you. There is increasingly good evidence for Mentalization Based Therapy (MBT) for people with a diagnosis of BPD. This provides group MBT sessions alongside individual sessions.

Expand full comment
Steve Stewart-Williams's avatar

Hadn't heard about that - thank you!

Expand full comment
Michael Magoon's avatar

I am curious how strong the effect was. A therapy can be statistically significant without making a big difference.

It is my belief that therapy can help the “Worried Well” somewhat, but not so much those who really need the help.

I am curious whether CBT was tested. It was my impression that this was one of the few types of therapy that actually had proven positive effects.

Expand full comment
Steve Stewart-Williams's avatar

Yep, clinical significance and statistical significance are very different things. The larger effect sizes are likely to be clinically significant; not so sure about the smaller ones.

I have the same impression about the worried well vs. those with more serious problems. That’s one reason I changed my mind about going into clinical psychology.

Most of the studies in the meta-analysis were on CBT, as there’s more research on CBT than any other form of therapy. Interestingly, though, the authors didn’t find any evidence that CBT is more effective than other therapies.

Expand full comment
Grainger's avatar

Also, I’ve learned that this is because therapies are therapist-relative. It fits the personality of the therapists. I’ve watched sessions where person-centered (Carl Rogers) works just fine. The therapist felt confident in this theory.

I use a person-centered technique to start sessions and move to CBT and REBT. It’s just up to the therapist.

Expand full comment
Puzzle Therapy's avatar

I wonder if there's a potential confounding variable of more structured, focused, behavioral therapies that tend to get used with anxiety-based diagnoses vs the greater variety (and often less behaviorally focused) of therapy types that would be used for the other diagnoses? Of course, that would not count for everything because there is a significant difference in the severity of some of these diagnoses, but maybe an interesting thread to pull on and investigate more?

Expand full comment
Steve Stewart-Williams's avatar

Yeah, that could be a factor. You’re thinking of highly structured practices like systematic desensitization, I assume?

Expand full comment
Puzzle Therapy's avatar

Yes

Expand full comment
Steve Stewart-Williams's avatar

Right. Other therapies try to be as structured as possible, but they’re not in the same league as systematic desensitisation. That would add noise to the system,

Expand full comment
Puzzle Therapy's avatar

Behavioral therapies like the ones typically used in anxiety based disorders, often have more clearly defined goals and outcomes that produce better data on their efficacy

Expand full comment
Grainger's avatar

As a therapists in training and long time pastoral counselor, I felt like that was the case before I decided to get clinically trained. It just seemed to be the case.

My population is men, couples, and parents. So I don’t usually dive too deep into psychopathology, though I’m being trained in it. This is good to know to understand how much effort should be put into various disorders.

Expand full comment