by Dr.Harald Wiesendanger– Klartext – 29. Okt. 2022 updated 2.Jan 2024
What the mainstream media is hiding
The professional organizations of psychological professionals have always reacted extremely irritably and insulted to research results that threaten their monopoly. You should listen to a wise bird from Wonderland.
How can one seriously claim that a five-year university degree (1), with a workload of at least 9,000 hours – including “practical placements” of at least 570 hours (Bachelor) plus 750 hours (Master) – does not provide any advantage in terms of competence for scientific psychologists? How could subsequent therapeutic training that costs tens of thousands of euros – with additional thousands upon thousands of hours of further theory, treatment under supervision, self-awareness, and practical activity – be essentially a waste?
Doubts about the expertise of psycho-specialized doctors seem even more insane. To become one, you must first have studied medicine for twelve to thirteen semesters. Only then can you concentrate on psychiatry and psychotherapy, and that takes five to six more years. Training to become a doctor costs the state around 200,000 euros per student – more than any other course of study (2) – and the subsequent further training to become a specialist costs twice to four times as much. (3) Shouldn’t this enormous effort reliably produce experts who easily overshadow lay helpers?
Experts base their outraged resistance primarily on the point of view that only experts can acquire suitable techniques to treat mental illnesses. Which amateur has mastered the delicate procedures of a Freudian analyst, a depth psychologist, according to C. G. Jung, a cognitive behavioral therapist?
Class arrogance on feet of clay
But upon closer inspection, it turns out, surprisingly, that this arrogance comes with feet of clay. In reality, techniques in psychotherapy are largely irrelevant.
Anyone who knows Lewis Carroll’s children’s book Alice in Wonderland will remember that strange race in which no one can find out how far and for how long the participants ran. When the cute bird Dodo is asked who the winner is, he says: “Everyone has won, and everyone has to get prizes.” In such a wonderful competition are all the psychotherapeutic procedures that leave those seeking help with the sweaty agony of choosing. Experts estimated their number at 300 to 400 at the end of the 1980s (4). A meta-analysis of almost 400 treatment comparison studies showed (5) that none of them do anything, none are always helpful, and none are clearly superior to the others. They are all approximately equally effective (6), and this situation is referred to as the “Dodo-Bird verdict” (7) and occasionally as the “Equivalence Paradox.”
In this light, the so-called “differential indication” – the assessment of which form of therapy is indicated for which disorder – turns out to be a dead end. If, on the whole, no method does more than the other, it is those who use it who make the difference; Patients need the right therapist.
Isolated studies have shown that a mentally ill person is more likely to benefit from a moderately structured, informal approach such as talk therapy if their need for self-determination is particularly pronounced or if they are very “reactive,” i.e., they switch to defense as soon as they feel under pressure. On the other hand, someone seeking help who tends to be submissive seems to benefit from instructive, encouraging, goal-setting procedures such as behavioral therapy. (8) But ultimately, it is not a methodological abstraction that takes people by the hand or gives them freedom, but rather the individual personality of the respective practitioner. Whatever he is after, he can achieve – or miss – using any technique.
This text is a revised excerpt from H. Wiesendanger: Psycholügen, Volume 3: Deep in the soul: a case for professionals?, Schönbrunn 1st edition 2017.
The cover image comes from Microsoft’s AI “Bing Image Creator.” This is how she illustrated my brief “Dodo Bird in Psychotherapy.”
The consequences of this series:
1 Extensively researched: Many laypeople can do more
3 Dodo Bird in the Psychotechnics Race
4 How much does psychotherapy really help?
5 Why is psychotherapy useful?
6 Stay ahead: Why some laypeople are better therapists
7 Embarrassing, telling: successful imposters
8 Psychotherapy as a source of danger
9 What many professionals can do better – and why
Remarks
1 “Gesetz über den Beruf der Psychotherapeutin und des Psychotherapeuten” vom 15.11.2019, https://www.gesetze-im-internet.de/psychthg_2020/BJNR160410019.html, § 9, Absatz (2)
2 Nach www.praktischarzt.de: „Medizin – der teuerste Studiengang“, abgerufen am 5.1.2017.
3 Nach Zimmer Eins – das Patientenmagazin 2/2016, S. 56: „Hauptsache gesund“.
4 Eckhard Giese/Dieter Kleiber (Hrsg.): Das Risiko Therapie, Weinheim 1989, S. 20.
5 Mary Lee Smith/Gene V. Glass: “Meta-Analysis of Psychotherapy Outcome Studies, “American Psychologist Sept. 1977, S. 752-760.
6 Den Forschungsstand hierzu fassen zusammen: B. E. Wampold: The Great Psychotherapy Debate. Models, Methods, and Findings, Mahwah/ London 2001; R. Dawes: House of Cards. Psychology and Psychotherapy Built on Myth, New York 1996; L. J. Groß: Ressourcenaktivierung als Wirkfaktor in der stationären und teilstationären psychosomatischen Behandlung, Dissertation, Nürnberg 2013.
7 Lester Luborsky/Barton Singer/Lisa Luborsky: “Comparative studies of psychotherapies: Is it true that ‚everyone has won and all must have prizes’? “, Archives of General Psychiatry 32 (8) 1975, S. 995-1008; siehe auch J. Siev u.a.: “The Dodo Bird, Treatment Technique, and Disseminating Empirically Supported Treatments”, The Behavior Therapist 32 (4) 2009.
8 K. Grawe/F. Caspar/H. Ambühl: „Die Berner Therapievergleichsstudie: Wirkungsvergleich und differentielle Indikation“, Zeitschrift für Klinische Psychologie 19/1990, S. 338-361; K. Grawe: „Psychotherapieforschung zu Beginn der neunziger Jahre“, Psychologische Rundschau 43/1992, S. 132-162, dort ib. S. 148-150.