by Dr.Harald Wiesendanger– Klartext – 24. Okt. 2022
What the mainstream media is hiding
As far as psychotherapy works: why does it do it? Suppose professionals achieve essentially the same things with various approaches and theories. In that case, their recipe for success may have little to do with what they learned during their respective training. What does it consist of, then?
From the “Dodo-Bird Paradox”, it follows: The results of different types of psychotherapy depend little or not at all on how they are achieved. So it has to be based on other factors: ones they all have in common, despite all the battles over demarcation.
The state of research on this leaves little to be desired regarding clarity: the deciding factor is what experts call non-specific impact factors. Psychotherapy, no matter what type, is only successful if the main participants, the therapist as well as the person being treated, contribute several things to it:
It depends on the client.
The person seeking help is most likely to benefit if they are able and willing to change. He is confident that the therapist can and wants to help him. He trusts him. He is open. He does not have excessive expectations and does not expect a lightning-fast, complete recovery of biblical proportions. He finds the external framework of the treatment, the healing setting, to be suitable, appropriate, and pleasant. He sees essential needs satisfied through the therapy. He feels valued, accepted, and understood and developed a feeling of belonging. He adopts the proposed explanation of his problem. He accepts the method(s) used. He is not deterred by his surroundings, including his most important people. He is cooperative, takes on therapy goals, and strives for them persistently.
What makes a good psychotherapist
And what about the helper? His efforts are beneficial if he successfully gains the client’s sympathy and trust. He is optimistic and conveys his confidence convincingly. He doesn’t appear strict, distant, and cold but friendly, approachable, warm-hearted, and emotionally involved. He radiates security, calmness, and experience. He seems open and honest. He states the problem in a way that makes sense to the client. (Whether the diagnosis is actually correct is secondary.) He focuses on the issue and offers an explanation for it that the client can understand: a plausible myth. (Whether it’s true is irrelevant.) He doesn’t seem absent but rather on task; he is not tense but relaxed. He is capable of empathy, which means he can take on the perspective of the person seeking help, put himself in their shoes, and empathize. (More on this in Volume 4 of my series Psycholyges: Stochern im Nebel.) He knows how to get a lively conversation going and maintain it. He doesn’t put on a grim expression but instead acts humorous. It motivates you to participate in the therapeutic process. The person seeking help should become a conscious, active self-healer, not remain an inactive recipient.
The helper considers the personal strengths of the person seeking help; he encourages him to become aware of, use, and be proud of them: skills, experiences, interests, and positive character traits. (Social scientists speak of empowerment.) He shows him appreciation and strengthens his self-esteem instead of badmouthing him for weaknesses and mistakes. He gives the impression of listening attentively and being interested. He adapts flexibly to unforeseen situations and surprising turns during therapy. He carefully clears up misunderstandings. He proves to be creative when using methods and offering interpretations. He succeeds in giving the client a new perspective on the problem and offers tips on how they can overcome it on their own. He shows him opportunities and shows ways out. It promotes sustainable social relationships.
None of this fundamentally overwhelms lay helpers. The professional can only do none of this, thanks to a scientific degree. He can’t do any of this until he has passed exams. He can do none of this better than before.
Is the relationship right?
What is no less important is the relationship quality that the helper and the help seeker build with each other. To achieve their common goal of eliminating internal stress, they perform a ritual together, the rules to which they must agree.
No matter how much effectiveness psychotherapies are believed to have by their supporters, one, like the other, fails when the main participants, helpers, and those seeking help are suspicious, rejecting, and hostile towards each other. If they don’t really get into conversation with each other. When one, or even both, see the prospects of success as bleak. It fails if the person seeking help cannot do anything with the diagnosis made, the explanation offered for their problem does not make sense to them, and the methods used are reluctant. It fails if his therapist seems insecure, disinterested, apathetic, or indifferent. It fails when he refuses to cooperate, deceives, and lies. The deciding factor in any psychotherapy is not the user but the person being treated – it is up to them to do the actual work.
As in medicine in general, the same applies to psychotherapy: all healing is ultimately self-healing. The client must be able and willing to pull themselves out of the mire. Otherwise, even the most promising approach will fail. The therapist can give suggestions, feedback, and advice; introduce new ideas; point out what has been tried and tested; correct misjudgments; open up new perspectives; show options for action; motivate, and warn of risks and dangers – ultimately, only the client can change their own thoughts, feelings, and actions.
In addition, many psychoprofessionals underestimate how important so-called “support networks” are in the social environment. Conflicts in relationships and family, anger at work, and persistent tensions among friends, clubs, the community, and the neighborhood can make progress more difficult, prevent it, or destroy it. (1) “Forty percent of the differences in treatment outcomes are due to factors outside of treatment,” estimates US therapy researcher Michael J. Lambert. (2) Psychotherapy reliably fails when the social environment destroys all efforts.
Differences in performance between therapists, regardless of school, have almost nothing to do with their preferred method. Mainly, they stem from the fact that their personality traits and social skills make them differently suited to accompanying those under pressure on their arduous journey. The suitability for this does not necessarily have to be based on particularly positive character traits. Sometimes, outspoken hallodris and charlatans are particularly good at persuading those seeking help to make changes when they act as the know-it-all who issues slogans of perseverance from above in a sonorous voice. Since Sigmund Freud, the unsurpassed charismatic, there have been several such clever psycho conductors in mental health medicine.
General impact factors enable lay helpers – as “Auswege” camps teach
General impact factors (3) explain why many laypeople can help people with psychological problems just as well as psychological experts: Each of us acquires the skills that are important not only in universities and academies but from childhood, in the course of our socialization.
The ability to incorporate such factors into treatment is what distinguishes lay helpers in the therapy camps at my Auswege Foundation. With an average age of well over fifty and mid-twenties of practice, they bring a lot of experience in dealing with those seeking help. They respond to the needs, questions, concerns, and fears of patients in an exemplary manner, as evaluations of completed questionnaires show: Over 98 percent of camp participants characterize their helpers as “safe,” “patient,” “polite,” “empathetic” and They perceive “encouraging” as “competent,” “confidence-inspiring,” “modest,” “convincing” and “unobtrusive.” Just as many would, therefore, “recommend them without reservation”.
Christine, Ulrike, Verena, and Regine, four trained, experienced psychotherapists, as well as Gisa and Milan, two experienced psychiatric specialists, received equal praise. The “way out” camps in which they took part enriched them enormously: not primarily through information advances thanks to superior specialist knowledge and psychotechnical sophistication, but through their warm, sensitive way of dealing with those seeking help, coupled with self-confidence and experience – through advantages However, the other, supposedly unqualified team members also knew how to contribute.
Among the many ingredients that together make up the recipe for success of the “way out” camps (4), these general factors are probably the deciding factor. From the opening event onwards, they consistently shape the way everyone involved works together. Breathtakingly quickly, they create an atmosphere whose intensity fascinates and moves me every time.
A look at the official program items of a typical camp day, with up to five individual appointments for each participant with different team members, leads to wrong conclusions. Basically, our patients and their relatives are advised and treated not just four to five times for 30 to 60 minutes a day – a single healing session takes place and it lasts two-thirds of the entire day, without a break: starting early in the morning with the common session Breakfast from eight o’clock until shortly before midnight, when the last rounds of discussions have broken up following the evening program. Healing takes place continuously for 15 to 16 hours: from the 15 to 20 team members, but also from the 20 to 30 patients and their relatives, regardless of age.
Together, they form a healing community in which everyone receives in return what they bring in: attention, concern, care, compassion, benevolence, and appreciation. This mixture brings most mentally stressed people into balance within a week more than any previous, often years-long professional care – more than numerous hospital stays lasting several weeks, than various, often years-long psychotherapies, than medication with lots of side effects. Doesn’t this clearly show how much more applied mental health medicine could achieve if it learned what is most important from the therapy camps run by the Foundation for Ways Out?
What makes psychotherapy seem effective
For many patients, for whom professional psychotherapy has undeniably benefited them enormously, such a view may seem outrageous, even absurd. “Without my therapist, I would still be an emotional wreck to this day; maybe I wouldn’t be alive anymore,” some say. “Neither my partner nor any of my relatives, not even my very best friends, had been able to help me before.”
But such subjective certainties may be premature. On the one hand, it can never be ruled out that grateful patients succumb to one of the most common fallacies: post hoc ergo propter hoc – “because I felt better after the therapy, I must have felt better because of them.” They fail to recognize that even the most severe mental misery can subside on its own over time. “Time heals all wounds,” as the saying goes, and there is undoubtedly a bit of truth in that. Fluctuations in intensity characterize the vast majority of psychological disorders. You rush to a psychotherapist when you’re feeling low, and even without him, sooner or later, things would most likely improve again.
Furthermore, the improvement could result from circumstances accompanying the therapy that the treatment had nothing to do with: for example, a new partnership, changes at work, a change of residence, family events, drastic encounters and experiences, a lucky coincidence, or an unexpected opportunity.
The inferiority of the lay helper: a “self-fulfilling prophecy”?
Furthermore, hardly any client is in the habit of distinguishing between specific and general influencing factors. By far, the most crucial general factor is himself: his willingness to accept and be changed by the therapy is ultimately the deciding factor. If those affected did not find the help in their immediate social environment for which they praise their therapist, it may be because they did not trust people close to them to provide such assistance. Therapists generally enjoy a tremendous amount of trust when it comes to people with psychological problems. If, as explained, their superiority comes from very few techniques and theories, then where does it come from?
The solution to the puzzle lies partly in a placebo effect: only the patient’s firm belief that psychotherapy brings more results makes it significantly more effective than what some laypeople would have to offer in terms of advice and support. What is crucial is the decision to accept the therapist’s expectation of success and to consider him or her competent enough to provide effective treatment.
All the status characteristics that professionals have over laypeople tempt you to do this: They have studied psychology or medicine, can demonstrate extensive practical training in addition to theoretical training, have academic titles, and must, therefore, be highly qualified. After all, psychotherapy is her profession. They welcome those seeking help in special rooms with a special ambiance. A more or less attractive practice sign hangs next to her doorbell. Specialist literature is piled up on their bookshelves.
They sprinkle impressive technical jargon into the conversation. They are considered respected actors in the healthcare system; doctors sometimes recommend them, and health insurance companies often cover the costs. They appear with the self-confidence of experts, create reports, reports, and invoices on attractive letterhead, and impress with business cards and flyers. But, to underline this again: As therapy research of the past decades has shown, in reality, not a single one of these characteristics is meaningful. It only becomes significant as a trapping that encourages good faith.
Why does someone with a problem still tend to prefer a professional to a lay helper? There are several other reasons for the placebo effect, most of which stem from short-circuits from unquestioned prejudices that are almost dogmatic in the age of expertocracy: professionals are more competent. Their training and diplomas guarantee quality. They have more professional experience. They could better determine and explain what’s going on with him. They had far more effective techniques to deal with his problem. Neither he nor those like him could judge what was missing. Mass media uncritically fuels such beliefs, and fellow human beings create additional pressure.
The starting point of the short path to becoming a professional helper is a capitulation to the spirit of the times: you agree to have your life problem defined as a mental illness and to be declared a patient. Anyone who is sick becomes a medical case; Anyone who is mentally ill is responsible for the field of psychiatry – and one of its main pillars, psychotherapy, is responsible for non-medicinal treatment.
The fact that it is part of the officially recognized health system gives it credibility and authority. To surrender and submit to it, to let it take responsibility for you, is an understandable tendency of people who, in acute life crises, and especially in chronic soul depressions, feel overwhelmed by the need to remain responsible citizens. They feel incompetent, helpless, and weak, and no layperson’s shoulders are broad enough to give them as much supposed security when leaning on them as someone who confidently dares to act as an expert because everyone thinks they are.
(Harald Wiesendanger)
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 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
10. Pragmatism instead of lobbying – For wise psycho-politics
Remarks
1 S. M. Monroe/D. F. Imhoff/B. D. Wise/J. E. Harris: “Prediction of psychological symptoms under high-risk psychosocial circumstances: Life events, social support, and symptom specificity “, Journal of Abnormal Psychology 92/1983, S. 338–350.
2 Michael J. Lambert: “Implications of outcome research for psychotherapy integration “, in J. C. Norcross/ M. R. Goldstein (Hrsg.): Handbook of Psychotherapy Integration, New York 1992, S. 94-129.
3 Siehe Jerome D. Frank: Persuasion and Healing. A Comparative Study of Psychotherapy (1961), 3. Aufl. Baltimore 1991. Franks „unspezifische Wirkfaktoren“ finden sich weitgehend wieder bei Hilarion G. Petzold: „Integrative Therapie – Transversalität zwischen Innovation und Vertiefung. Die Vier Wege der Heilung und Förderung’ und die ‚14 Wirkfaktoren’ als Prinzipien gesundheitsbewusster und entwicklungsfördernder Lebensführung“, Integrative Therapie 3/2012.
4 Siehe Harald Wiesendanger: Heilzauber oder was? Das Erfolgsgeheimnis der „Auswege“-Camps, Schönbrunn 2014.
Titelbild: Drazen Zigic/Freepik