How is therapy effective when you (typically) only talk for one hour per week?
In: 306
Contrarian/personal take: therapy once a week for an hour doesn’t really work/didn’t do much **for me.**
When I was dealing with depression last year, I decided to seek therapy on one of the online sites. I talked to a therapist once a week. For the most part there wasn’t much follow-up inbetween sessions as she was mos tlikely seeing dozens of other patients.
It did kind of feel like every week was mostly an open forum for me to share how I was feeling, what I was up to, etc. That could have just been my experience though, I was trying to pintpoint the root of my depression.
The other challenge I found was that by the time I came to a realization after the session or sometime during the week, I pretty much forgot about it by the time the next session came. Or it no longer seemed as relevant.
Eventually I did fix my problem with depression by stopping a medication.
**I just think therapy as it stands is kind of shitty for a multitude of reasons:**
* There’s just not enough therapists. It’s how you end up with these online sites where someone is seeing most likely dozens of patients a week. I don’t expect anyone to remember details about me or be able to make much progress if they’re juggling a dozen other people at the same time.
* There’s not enough/frequent contact. Once a week for an hour really isn’t much time. Especially if you’re dealing with serious/strong feelings or an actual mental disorder. By the time you get into the flow of opening up, it could be 30 minutes gone.
* Video chats suck. I noticed one of my therapists was scrolling on FB or some other site while I was talking. I could see the reflection in her glasses. Once I was done talking she’d make a generic comment/question. Beyond that, I don’t think the experience of talking to a human on a screen and through your camera is the same as talking to someone in a closed room in person. At the very least, your therapist won’t be scrolling through pinterest or whatever during your in-person session.
* Personal/mental problems are highly complex. It’s just hard to find someone who specializes in helping you with your specific problem. It’s also hard to find someone who understands your unique background (race, ethnicity, gender, class, etc.). Compounded with the shortage of therapists it just exasperates the issue further. I remember trying to find a male therapist and they were probably 10-20% of the overall pool of available therapists.
My therapist mostly listened for three or four sessions. Then she tied up everything she heard and gave me one of the heaviest “ah-ha” moments I had had in a long time. I sat there and cried for like 15 minutes because she hit the nail on the head and it was right in front of me the whole time, but it took a second pair of eyes and ears to see it. That one moment of realization helped me re-calibrate a number of very important things in my life that all branched out into more things. I am now a healthier person than I was. Talk therapy is cool.
My therapist mostly listened for three or four sessions. Then she tied up everything she heard and gave me one of the heaviest “ah-ha” moments I had had in a long time. I sat there and cried for like 15 minutes because she hit the nail on the head and it was right in front of me the whole time, but it took a second pair of eyes and ears to see it. That one moment of realization helped me re-calibrate a number of very important things in my life that all branched out into more things. I am now a healthier person than I was. Talk therapy is cool.
Contrarian/personal take: therapy once a week for an hour doesn’t really work/didn’t do much **for me.**
When I was dealing with depression last year, I decided to seek therapy on one of the online sites. I talked to a therapist once a week. For the most part there wasn’t much follow-up inbetween sessions as she was mos tlikely seeing dozens of other patients.
It did kind of feel like every week was mostly an open forum for me to share how I was feeling, what I was up to, etc. That could have just been my experience though, I was trying to pintpoint the root of my depression.
The other challenge I found was that by the time I came to a realization after the session or sometime during the week, I pretty much forgot about it by the time the next session came. Or it no longer seemed as relevant.
Eventually I did fix my problem with depression by stopping a medication.
**I just think therapy as it stands is kind of shitty for a multitude of reasons:**
* There’s just not enough therapists. It’s how you end up with these online sites where someone is seeing most likely dozens of patients a week. I don’t expect anyone to remember details about me or be able to make much progress if they’re juggling a dozen other people at the same time.
* There’s not enough/frequent contact. Once a week for an hour really isn’t much time. Especially if you’re dealing with serious/strong feelings or an actual mental disorder. By the time you get into the flow of opening up, it could be 30 minutes gone.
* Video chats suck. I noticed one of my therapists was scrolling on FB or some other site while I was talking. I could see the reflection in her glasses. Once I was done talking she’d make a generic comment/question. Beyond that, I don’t think the experience of talking to a human on a screen and through your camera is the same as talking to someone in a closed room in person. At the very least, your therapist won’t be scrolling through pinterest or whatever during your in-person session.
* Personal/mental problems are highly complex. It’s just hard to find someone who specializes in helping you with your specific problem. It’s also hard to find someone who understands your unique background (race, ethnicity, gender, class, etc.). Compounded with the shortage of therapists it just exasperates the issue further. I remember trying to find a male therapist and they were probably 10-20% of the overall pool of available therapists.
Contrarian/personal take: therapy once a week for an hour doesn’t really work/didn’t do much **for me.**
When I was dealing with depression last year, I decided to seek therapy on one of the online sites. I talked to a therapist once a week. For the most part there wasn’t much follow-up inbetween sessions as she was mos tlikely seeing dozens of other patients.
It did kind of feel like every week was mostly an open forum for me to share how I was feeling, what I was up to, etc. That could have just been my experience though, I was trying to pintpoint the root of my depression.
The other challenge I found was that by the time I came to a realization after the session or sometime during the week, I pretty much forgot about it by the time the next session came. Or it no longer seemed as relevant.
Eventually I did fix my problem with depression by stopping a medication.
**I just think therapy as it stands is kind of shitty for a multitude of reasons:**
* There’s just not enough therapists. It’s how you end up with these online sites where someone is seeing most likely dozens of patients a week. I don’t expect anyone to remember details about me or be able to make much progress if they’re juggling a dozen other people at the same time.
* There’s not enough/frequent contact. Once a week for an hour really isn’t much time. Especially if you’re dealing with serious/strong feelings or an actual mental disorder. By the time you get into the flow of opening up, it could be 30 minutes gone.
* Video chats suck. I noticed one of my therapists was scrolling on FB or some other site while I was talking. I could see the reflection in her glasses. Once I was done talking she’d make a generic comment/question. Beyond that, I don’t think the experience of talking to a human on a screen and through your camera is the same as talking to someone in a closed room in person. At the very least, your therapist won’t be scrolling through pinterest or whatever during your in-person session.
* Personal/mental problems are highly complex. It’s just hard to find someone who specializes in helping you with your specific problem. It’s also hard to find someone who understands your unique background (race, ethnicity, gender, class, etc.). Compounded with the shortage of therapists it just exasperates the issue further. I remember trying to find a male therapist and they were probably 10-20% of the overall pool of available therapists.
You spend the week thinking, “Oh, this is something I want to remember to tell my therapist.” So it becomes kind of an all the time thing, but not a burden.
You spend the week thinking, “Oh, this is something I want to remember to tell my therapist.” So it becomes kind of an all the time thing, but not a burden.
You spend the week thinking, “Oh, this is something I want to remember to tell my therapist.” So it becomes kind of an all the time thing, but not a burden.
The short answer is that [nobody knows the mechanism behind why psychotherapies are effective](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7180170/) [technical review]. They are consistently measured to be effective, however, and weekly sessions are measured to be a very effective frequency. It’s an empirically verifiable medicine with no decent theory behind it (and in medicine, this is [not unusual](https://www.sgu.edu/blog/medical/how-does-anesthesia-work/)).
There are many types of psychotherapy that meet in several different ways with different frequencies and different techniques. When you talk about most psychotherapies used clinically by trained doctors and professional therapists, they are [conclusively effective, though underutilized](https://www.apa.org/news/press/releases/2012/08/psychotherapy-effective) — with caveats that therapy should be consistent and that it is usually more effective in conjunction with other interventions. While consistency — regular timely attendance — is important, therapy can also be optimized for frequency of sessions.
Many studies have converged that weekly sessions are quite effective for a variety of disorders for most patients, but it has also been measured that [increased frequency of treatment can significantly increase effectiveness of psychotherapy in more severe cases in the first few months](https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-019-2214-4) [technical review]. So why don’t psychotherapists typically meet more than weekly? The limiting factor is often the limited availability of medical resources — too few and unevenly distributed doctors, MSW therapists, and the like.
(Note that I’m not sure to what extent you’ll accept an explanation of a mechanism for effectiveness. It is definitely known that psychotherapy alone will change brain chemistry, both temporarily and permanently. You can also pick out specific examples: it is clear that in certain elements of CBT it incorporates something like classical conditioning. But I think asking a question of “how it works” for a medicine in general usually expects a deeper response.)
(Note there was a famous 2018 review that suggested a range of psychotherapies were significantly less effective than believed. That review has been [countered in several re-reviews](https://www.cambridge.org/core/journals/epidemiology-and-psychiatric-sciences/article/is-psychotherapy-effective-a-reanalysis-of-treatments-for-depression/5D8EC85B6FA35B5CEE124381F18E51B9), which is an interesting read overall. )
The short answer is that [nobody knows the mechanism behind why psychotherapies are effective](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7180170/) [technical review]. They are consistently measured to be effective, however, and weekly sessions are measured to be a very effective frequency. It’s an empirically verifiable medicine with no decent theory behind it (and in medicine, this is [not unusual](https://www.sgu.edu/blog/medical/how-does-anesthesia-work/)).
There are many types of psychotherapy that meet in several different ways with different frequencies and different techniques. When you talk about most psychotherapies used clinically by trained doctors and professional therapists, they are [conclusively effective, though underutilized](https://www.apa.org/news/press/releases/2012/08/psychotherapy-effective) — with caveats that therapy should be consistent and that it is usually more effective in conjunction with other interventions. While consistency — regular timely attendance — is important, therapy can also be optimized for frequency of sessions.
Many studies have converged that weekly sessions are quite effective for a variety of disorders for most patients, but it has also been measured that [increased frequency of treatment can significantly increase effectiveness of psychotherapy in more severe cases in the first few months](https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-019-2214-4) [technical review]. So why don’t psychotherapists typically meet more than weekly? The limiting factor is often the limited availability of medical resources — too few and unevenly distributed doctors, MSW therapists, and the like.
(Note that I’m not sure to what extent you’ll accept an explanation of a mechanism for effectiveness. It is definitely known that psychotherapy alone will change brain chemistry, both temporarily and permanently. You can also pick out specific examples: it is clear that in certain elements of CBT it incorporates something like classical conditioning. But I think asking a question of “how it works” for a medicine in general usually expects a deeper response.)
(Note there was a famous 2018 review that suggested a range of psychotherapies were significantly less effective than believed. That review has been [countered in several re-reviews](https://www.cambridge.org/core/journals/epidemiology-and-psychiatric-sciences/article/is-psychotherapy-effective-a-reanalysis-of-treatments-for-depression/5D8EC85B6FA35B5CEE124381F18E51B9), which is an interesting read overall. )
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