by Dr.Harald Wiesendanger– Klartext – 27. Okt. 2022
What the mainstream media is hiding
Underestimated amateurs can usually keep up with mental health professionals whenever therapy researchers pit the two against each other. This extremely embarrassing factual situation contains unparalleled health policy and economic explosives. That’s why there seems to be a tacit agreement among experts not to make too much noise about it.
Many laypeople are no worse at helping people with psychological problems than psycho professionals: In the mental healing industry, this would continue to be one of the best-kept trade secrets and kept under wraps as much as possible, like the truth about manipulated engine controls at Germany’s largest car companies – if rebellious system critics didn’t stupidly publish it in specialist magazines and internet portals would have discovered.
Sweeping under the carpet no longer works. The genie is out of the bottle, waiting to drive away smokescreens and spark a long-overdue debate about the psychological arm of our healthcare system. The price is high: at stake for the actors and beneficiaries of today’s psychomedicine is nothing less than expert status, income and influence, benefits and privileges, social prestige and self-image.
Evidence-based embarrassment
One of the most cited social scientists of our time in specialist circles got the ball rolling: the US psychologist Robert Carkhuff, whose bestseller has sold over a million copies worldwide. In 1968, he presented an evaluation of 30 studies that compared what untrained and academically trained spiritual helpers could achieve. (1) It left nothing to be desired in terms of clarity: professionals consistently proved to be inferior. “It is obvious,” says Carkhuff, “that laypersons can learn to produce beneficial changes in clients in a short period of time. (…) We can no longer afford the luxury of assuming greater effectiveness of professional treatments at their expense.”
Six years later, Averil Karlsruher, a Canadian psychologist at the University of Manitoba in Winnipeg, conducted 27 studies comparing professional and lay practitioners in inpatient psychiatric facilities. The professionals performed worse in 26, and in one, they achieved almost the same results as the amateurs. (2)
Neither work initially received any significant attention among experts – surprisingly, given their explosive nature. Their shameful finding only became heated when a professor of clinical psychology at Loyola University of Chicago, Joseph A. Durlak, backed it up with another, even larger and more sophisticated meta-analysis. He concentrated on 42 comparative studies that met specific minimum requirements for the procedure and weighted them according to the quality of their design. He had previously sorted out mere descriptions of individual cases, as well as works that only used the therapist’s subjective assessment as a criterion for success.
But even after this preselection – with two publications from Carkhuff’s database, five from Karlsruher’s and 35 others – Durlak could not give the all-clear; on the contrary: in twelve studies, lay helpers proved to be clearly superior, and in 28, they were at least equivalent; Only in one – a project with 234 overweight adults – did professionals do a little more. Amateurs, Durlak summarized, “achieve the same or significantly better results in the clinical area than professionals.” Accordingly, “education, training and experience in the clinical area are not necessary prerequisites for an effective helper personality.” (3)
Now, finally, a heated debate began in expert circles. In terms of spite, she was sometimes hard to beat. Angry critics alleged “misleading” and “fraudulent representations.” Four further complex meta-analyses were carried out within eight years; All of them were aimed at convicting Durlak of severe omissions and errors. The first well-known doubter to attack Durlak’s original studies and exclude supposedly inadequate ones was Michael T. Nietzel, a professor at Missouri State University in Springfield and its president for six years. According to standards that seemed strict enough to him, he had to sheepishly admit in 1981: In fact, “lay helpers (…) achieve the same or better results than therapists with the highest degrees.” (4)
In 1984, a professor from New Zealand, John Allan Hattie of the University of Auckland, also set out to pick apart Durlak’s data – and ultimately only confirmed his conclusions. (5)
“Does professional training make a therapist more effective?” asked psychology professor Jeffrey S. Berman from the University of Memphis shortly afterward. “As we have to admit, the answer is: no,” concluded its meta-analysis in 1985. “Trained and untrained therapists achieve comparable results. (…) The superiority of the professionally trained therapist remains an unproven claim.” (6)
The most significant number of comparative studies was reviewed in 1987 by a German research team: Thomas Gunzelmann from the Department of Medical Psychology at Leipzig University Hospital, Günter Schiepek from the Institute for Synergetics and Psychotherapy Research at Paracelsus University Salzburg, and Hans Reinecker, chair of clinical psychology and psychotherapy at the university Bamberg.
After extensive literature research, they considered no fewer than 184 comparative studies, as well as 142 more in addition to Durlak and Hattie’s source material. And they also had to confusingly certify that lay helpers had “adequate therapeutic effectiveness” because they “actually found some arguments” that “make them appear in a favorable light.” (7)
From this course of discussion, Durlak, who was first scolded and then pardoned, drew the obvious conclusion: “If conflicting authors reach similar conclusions, this should have particular weight.” (8)
To say soberly that this disturbing state of affairs has not been “duly addressed” by experts since then (9) would be a gross understatement. Shouldn’t Durlak’s findings, which have been confirmed several times, immediately have made waves, especially since they blatantly contradicted the academic self-image?
The lake rests quietly.
Nothing like that happened. The lake has been lying quietly ever since, and the experts have remained silent. Durlak’s discussion thread has been lying around in tatters for over half a century now, and no one would dream of picking it up. Congresses, symposiums, conferences about it? Zero. In specialist committees and committees: not an issue. In the curricula and courses of the psychology faculties: not provided. In common textbooks for students: non-existent. In magazines, information brochures, and professional organization websites: not a word about it.
Within the industry, the keyword “Durlak” raises hackles just as reliably as “Snowden” among American secret service agents, “Küng” among Catholic clerics, and “Wagenknecht” among members of the “Left.” The guild is quietly guarding a highly explosive secret: Tons of explosives are stored in their home, at least as explosive as anything that bombing jihadists could ever bring in, not lethal, but threatening to existentially. If someone held a match to their match, the whole store might blow up in their faces. This is obviously about “the suppression of knowledge,” says educational and cultural scientist Hildegard Müller-Kohlenberg from the University of Osnabrück, who dedicated a critical book to the topic of “lay competence in the psychosocial area.” (10)
A revolution is necessary.
And that’s why a revolution is necessary – in the word’s original sense. The late Latin word revolutio means “rolling back,” and that is precisely what it is about: not about a utopian-intoxicated introduction of something that has never existed before, but about reflecting and restoring. For thousands of years, lay psychotherapy played an outstanding role in the care of the mentally ill.
Until recently, it was largely unrivaled, and outside of the First World, it continues to be so. Until well into the 20th century, a mentally ill person only came under professional supervision when he was so confused and so dangerous to others and himself that his overwhelmed relatives thought it best to leave him in a mental asylum. On the other hand, less severe spiritual hardships were either overcome without outside help through prayer, work, self-discipline, distraction, or patient waiting. Or the clan, the family group, the best friends, a good neighbor, the church community took care of them.
There was neither a need nor a demand for professional psychotherapy, and at least outside of Western industrialized nations and emerging developing countries, nothing has changed to this day. In Haiti and Madagascar, in Mali and Mongolia, in Bolivia and Botswana, in Polynesia and Uzbekistan, soul mining is not even remotely booming. (11)
On the other hand, she celebrates triumphal processions where the social connective tissue dissolves. Where interpersonal closeness and depth is lost. Where Friends for Life can be seen primarily in dime novels and old black-and-white films. Where reliable, crisis-proof, long-lasting relationships are becoming increasingly rare and appear to be terminable and replaceable at any time.
In the age of single households, divorced orphans and old people thrown away in homes, of ego-groups and LABs (“life-stage companions”), of Facebook trivialities, of 140-character tweets, text snippets, and smiley communication, of rivalry and competitive envy at work, from anonymous tenants living next to each other in high-rise apartments or terraced house lots, social warmth is moving towards an ice age temperature level in which those who are laboring and burdened freeze even more quickly than they already do.
In times of personal crisis, they feel alone, misunderstood, unloved, and lonely. The fact that some US psychotherapists can successfully attract customers with the slogan Rent a Friend speaks volumes.
The much-praised “psychoanalytic revolution” since its founder, Sigmund Freud, has been celebrated as a world-historical titan on a par with Darwin and Einstein, has contributed. Previously, when we were feeling bad, we were simply sad, insecure, anxious, discouraged, shaken, dissatisfied, shy, brooding, wistful, angry, bitter, unbalanced, fickle, or withdrawn.
But now doctors have discovered that our soul is actually an extremely fragile, highly complex something with an unexpected, mysterious life of its own that is inaccessible to consciousness, full of mysterious peculiarities such as dark urges from the depths of the “id”, powerful control instances, sophisticated defense mechanisms and repressed ones desires. People were amazed to learn about the significance of a slip of the tongue, infantile sexuality and fixed libido, the Oedipus complex, penis envy, and the hidden eroticism of every dream.
The soul became a minotaur labyrinth whose owner must wander without knowing. Doesn’t it go without saying that only the expert can have Ariadne’s thread that leads out of the dark confusion?
General belief in science and media propaganda also contributed to bringing lay aid into disrepute. The promise of “self-optimization” as the key to happiness has recently become particularly powerful: using suitable psychological techniques, she implanted a firm belief in the hanging heads of gullible people who feel weak, inferior, unsuccessful, unfulfilled, despondent, anxious, and unhappy one can change profoundly, free oneself from annoying weaknesses and flaws, and bring a magnificent “true self” to light.
Unimagined creative potentials, previously imprisoned in the depths of the soul, should finally be able to be unleashed, brought to light, and brought to full development under expert guidance. The crouched, paralyzed ego should grow wings in order to soar up to a new, completely wonderful existence: a message promising self-redemption that sounds just as seductive to perfectly healthy housewives, retail salespeople, office assistants, and managers as it does to the ears of neurotics. How could laypeople have the faintest idea of the fabulous techniques that are supposed to bring about such salvation reliably?
Shaky border fences
It is sometimes said that laypeople only deal with relatively harmless everyday problems, while professionals also deal with “serious, deep, complex and far-reaching problems.” (12) Anyone who considers how often problems of any level of difficulty are successfully addressed among partners, friends and family members, while they remain unsolved in professional practices, can only see this as a marketing rumor as long as empirical research does not prove otherwise, Durlak refutes.
Laypeople can, at best, advise, but not treat, say, professionals and warn against “mixing.” (13) But what is the fundamental difference between the two? Doesn’t every practitioner give advice? Doesn’t every consultant treat? Psychotherapy, we are vaguely told, offers a “healing discourse,”; “treats people suffering from illnesses,” and uses “interpretive and revealing techniques.” Advice, on the other hand, merely brings about an “open help discourse”; just look for “a good solution” and use “supportive techniques” if necessary. (14) Aren’t such boundaries arbitrary and unrealistic?
In everyday life, as well as in the summer camps at my Auswege Foundation, they become blurred, and the transitions are fluid. Lay people who advise their neighbors sensitively and understandingly – whether in a one-on-one conversation or a group – can also interpret, reveal, and have a healing effect. They use psychotherapy procedures largely intuitively but surprisingly successfully. On the other hand, professional therapists are, of course, also open, supportive, and solution-oriented. Furthermore, numerous comparative studies show that counseling and psychotherapy are, all in all, equally effective. (15)
It is said that professionals take a lot more time. This is also absolutely necessary. Because the internal processes that trigger them must get going very gently and be pushed forward carefully. But what are the time advantages of help that usually ends on time after 45 of more than 10,000 weekly minutes? Which is not available when it is most necessary but is only available strictly according to the calendar?
In any case, no unprofessional helpers watch the clock in the “Auswege” camps. He is available at any time. And are therapeutic processes that progress at a snail’s pace fundamentally more desirable than those that quickly lead to solutions? When it comes to assisting, as in general, slowness is not a value in itself.
What counts is the result. For psychoanalysts, patients lie on the couch for an average of four years or 371 hours. (16) The majority of people feel significantly worse afterward than those who are mentally stressed after one to two dozen sessions over the course of an “Auswege” camp week.
There is, therefore, no evidence that academically trained, state-licensed helpers are actually experts in the means by which mental illness can be counteracted. So, there is no reasonable reason to exclude laypeople from providing medical care to the mentally ill. Taking away the monopoly on treating mental health problems from doctors and psychotherapists – and involving suitable amateurs – could make a significant contribution to curbing the cost explosion in the healthcare system.
For the Auswege Foundation, this means that there is nothing wrong with having people with psychological problems cared for in their therapy camps by people who are untrained in medicine and psychotherapy and who have long since proven that they can do this.
(Harald Wiesendanger) – Dr.Harald Wiesendanger
See also > Nine days in the future – from the “Auswege” camp to the clinic of the future.
This text is a revised excerpt from H. Wiesendanger: Psycholügen, Volume 3: Seelentief: Ein Fall für Profis?, Schönbrunn 1st edition 2017.
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 beneficial?
6 Why some laypeople are better therapists
7 Embarrassing, telling: successful imposters
8 Psychotherapy as a source of danger
9 What some professionals can do better – and why
10. Pragmatism instead of lobbying – For wise psycho-politics
Remarks.
1 Robert R. Carkhuff: „Differential functioning of lay and professional helpers“, Journal of Counseling Psychology 15 (2) 1968, S. 117-126, dort S. 122.
2 Averil E. Karlsruher: „The nonprofessional as a psychotherapeutic agent“, American Journal of Community Psychology 2 (1) 1974, S. 61-77.
3 Joseph A. Durlak: „Comparative effectiveness of paraprofessional and professional helpers“, Psychological Bulletin 86 (1) 1979, S. 80-92, dort S. 85.
4 s. M. T. Nietzel/S. G. Fisher: „Effectiveness of professional and paraprofessional helpers: A comment on Durlak“, Psychological Bulletin 89 (3) 1981, S. 555-565.
5 J. A. Hattie/C. R. Sharpley/H. J. Rogers: „Comparative effectiveness of professional and paraprofessional helpers“, Psychological Bulletin 95 (3) 1984, S. 534-541.
6 J. S. Berman/N. C. Norton: „Does professional training make a therapist more effective?“, Psychological Bulletin 98 (2) 1985, S. 401-407, dort S. 405.
7 T. Gunzelmann u.a.: „Laienhelfer in der psychosozialen Versorgung …“, a.a.O., S. 379.
8 Joseph A. Durlak: „Evaluating comparative studies of paraprofessional and professional helpers: A reply to Nietzel and Fisher“, Psychological Bulletin 89 (3) 1981, S. 566-569.
9 Hildegard Müller-Kohlenberg: Laienkompetenz im psychosozialen Bereich, Opladen 1996, S. 5.
10 Müller-Kohlenberg, a.a.O., S. 19.
11 On the other hand, a sharp increase in demand for psychotherapy has recently been reported from Japan, China, and Thailand, and also from parts of Africa – from everywhere where industrial development is advancing rapidly, and clan society is collapsing; see Christina Fürst: “Psychotherapy is booming worldwide,” Focus Online May 5, 2006.
12 S. Schiersmann/H.-U. Thiel: „Beratung als Förderung von Selbstorganisationsprozessen – eine Theorie jenseits von „Schulen“ und „Formaten“, in dies. (Hrsg.): Beratung als Förderung von Selbstorganisationsprozessen, Göttingen 2012, S. 14-78.
13 R. Ningel: Methoden der Klinischen Sozialarbeit, Stuttgart 2011, S. 211.
14 Gesammelte Zitate aus F. Engel/F. Nestmann/U. Sickendiek: „’Beratung’ – ein Selbstverständnis in Bewegung“, in dies. (Hrsg.): Das Handbuch der Beratung, Band 1: Disziplinen und Zugänge, Tübingen 2004, S. 37; R. Schwing/A. Fryszer: Systemisches Handwerk – Werkzeug für die Praxis, Göttingen 2009, S. 12; H. Gutsche: „Abgrenzung und Gemeinsamkeiten von Psychologischer Beratung vs. Psychotherapie“, Paracelsus Magazin 1/1999.
15 Entsprechende Untersuchungen fasst die Erziehungswissenschaftlerin Hildegard Müller-Kohlenberg zusammen in ihrem Buch Laienkompetenz im psychosozialen Bereich, a.a.O.; dies.: „… hilfreich und gut!’ Die Kompetenz der Laien im psychosozialen Bereich“, in: Diözesan-Caritasverband für das Erzbistum Köln (Hrsg.): Laienkompetenz. Wirksame Arbeit von Ehrenamtlichen in psychosozialen Handlungsfeldern, Köln 2000, S. 19-35.
16 Nach Deutsches Ärzteblatt 98 (30) 2001: „Psychoanalyse: Schwierige Evaluation“.
Titelbild: Drazen Zihic/Freepik