The Phobic Avoidance of Attending to Real World Mental Health Outcomes


When I look at mental health research, I notice a startling avoidance of real-world outcome measures. It seems almost phobic. Yet this type of outcome should be considered the most important. After all, who cares whether some arbitrary measure goes up or down slightly after a week or two? What we care about should be whether people have improved quality of life over the long term. Can they get back to doing the things they used to do? Do they participate in the world, socially, at work? Do they enjoy their hobbies?

So why do researchers avoid asking these questions?

A black man in a suit stands with fingers in his ears as if pretending not to hear. His eyes to the side as if nervous.One big reason is that researchers are incentivized to find a positive effect. The motto of academia is “publish or perish,” and everyone knows that null effects are rarely published. But your job may depend on your ability to publish your next study. Even worse, plenty of researchers are funded by the pharmaceutical and device industries—corporations that obviously are hoping you find a nice effect for their drugs and devices.

Even with the best of intentions, though, the people who are testing therapies are often the people who invented the therapy and their disciples—who obviously have at least an unconscious bias, hoping that their personal theory works!

So, consciously or unconsciously, researchers tend to accept a lower threshold for proof of effectiveness. It’s difficult to actually improve people’s real lives significantly, and it’s a lot easier to use a ton of arbitrary metrics and find at least one “statistically significant” effect over a short time. The upshot is, to paraphrase the Dodo in Alice in Wonderland, “all medications and psychological therapies are winners and all must have prizes.”

And it seems that the media, politicians, and midlevel healthcare bureaucrats similarly have no interest in examining the validity of outcome measures. Instead, they pass on oversimplified understandings and glib slogans as if they encapsulate the nuances of what is actually quite controversial research. Most have the best of intentions to be a “mental health advocate,” and they’re told by establishment figures that any criticism of the existing system would be “stigmatizing” and “stop people from getting treatment”—treatment that we only assume works, again, based on arbitrary statistical outcomes over the short-term, not real-world improvement in the long-term.

In the worst-case scenario, researchers and activists who note the misleading research and conclusions dripping with “spin” in an attempt to improve the system are called “antipsychiatry” and marginalized within their own communities.

One searches in vain for studies that ask, after treatment, “Are you back to your old self?” and, importantly, “for how long?” These are the outcomes that patients really care about. Without such questions it is impossible to chart the trajectory of a person’s functioning. Such questions are at the heart of really listening to the patient. Without that, any therapeutic edifice crumbles. But it is not rocket science, just basic respect!

At best, and rarely, studies will report on the proportion of people who lose their diagnostic status—“recovered”—as assessed by an independent clinician. But these don’t indicate the duration of recovery. Do you lose your diagnostic status after two weeks, but then worsen again by a month?

Symptom Reduction vs Added Value 

Finding the right psychological treatment for the right disorder is the window through which CBT researchers have gazed for decades. Likewise, psychiatrists have gazed through a similar window, which van Os and Guloksuz call “finding the right medication for the right brain disease.” Whether therapists or psychiatrists, researchers and clinicians have looked predominantly at symptom reduction, rather than whether treatment has provided added value to the client’s life. And all of this is usually rated by the clinician—rarely do we ask clients what they think about the treatment.

There has however been some limited success in the application of CBT to depression and some anxiety disorders, at least in randomised controlled trials. But even here researchers conclude “CBT is probably effective in the treatment of MDD, GAD, PAD and SAD; that the effects are large when the control condition is waiting list, but small to moderate when it is care-as-usual or pill placebo; and that, because of the small number of high-quality trials, these effects are still uncertain and should be considered with caution.”

Similarly, other researchers found that CBT had a large effect for treating OCD, and a moderate effect for treating PTSD. But beyond these DSM diagnoses, there is a dearth of credible supportive evidence.

Evolution or Dissolution?

It is the 50th Anniversary of the British Association for Behavioural and Cognitive Psychotherapy, the self-proclaimed lead organisation for CBT in the UK. The recent annual conference included a keynote speech called “On the Evolution of Cognitive Behaviour Therapy: A Four-Decade Retrospective and a Look to the Future.”

But evidence that it has evolved is sparse to non-existent. In 2008, Ost examined the methodology of what were then termed third-wave CBT therapies and concluded that the methodology employed made them significantly less reliable than the early pre-millenium CBT studies. He opined that the third-wave therapies would not qualify as evidence-based, despite yielding evidence of significant effect sizes. The evidence for the small, incremental changes in complexity and greater effectiveness of CBT is simply not there. Rather than evolution, we have evidence of the operation of the 2nd law of thermodynamics, in that therapeutic energies are being made available in less useful ways—dissolution.

Dissolution Under the Microscope

The PICOTS framework is a mnemonic used by the FDA to define evidence-based medicine. The “O” refers to outcomes and the FDA argues that these must be “outcomes that matter to patients and which predict long-term successful results.” Essentially, no cooking the books with small but statistically significant differences in outcome between an intervention and its comparator (the “C” of the mnemonic), ideally an active placebo.

The “P” stands for population, with a prerequisite to specify clearly who received the intervention, so that other researchers can replicate the findings with the same group of people. The “I” stands for intervention and requires a clear elaboration of what the treatment involved. For psychological therapies, this means the publication of a manual. The “T” refers to timeframe: how long have the treatment effects lasted. Finally, “S” refers to the treatment setting (e.g., primary care).

Over the past 40 years, psychological therapy (mainly CBT) studies have increasingly paid lip service to PICOTS. They have progressively looked less like the original pioneering efficacy studies. There has been a drift to reliance on self-report measures to define a population (P), as opposed to defining a population with a “gold standard” diagnostic interview—largely on the grounds of cost and expediency. Outcomes (“O”) have been progressively less likely to be assessed by independent blind raters.

For example, since the millennium there has been the development and evaluation of low-intensity CBT (typically defined as 6 hours or less of therapist contact). In none of these has there been an independent blind rater; outcome has always been assessed by self-report and rarely has a diagnostic interview served as the gateway into the study. Yet, in the UK, these low-intensity treatments are the first-line treatments for depression and the anxiety disorders.

Not only has the National Institute of Health and Care Excellence (NICE) endorsed the usage of low-intensity CBT, but they have recently advised that in the first instance therapists should market eight sessions of group CBT for depression.

The lack of any credible evidence on real-world impact and duration of gains troubles them not. It appears an answer to the managerial dream of throughput. Therapies are accessed and patients axed.

CBT and Antidepressants in Practice

There is nothing in the arrangement of routine psychological therapy services that guarantees that a) the “right” disorder will be identified and b) the “right” treatment will be forthcoming. Routine services, such as IAPT in the UK, do not make diagnoses.  In a just-reported paper by Clark et al (2022), IAPT clinicians were asked to refer patients to a social anxiety disorder study, but only half the patients referred were found to have the disorder in the study diagnostic assessment.

Thus, left to their own devices, the routine clinicians would have been providing inappropriate treatment to 1 in 2 patients. There can be no certainty that the treatment provided in routine practice is a bona fide treatment, as fidelity checks have never been made. Fidelity checks are disorder specific, with matching treatment targets and interventions. For example, in depression, tackling the loss of the pleasure response (anhedonia) with activity scheduling.

There is a potency of treatment gap between the interventions used in randomized controlled trials and their translation into routine practice. A paper published in the Journal of Psychiatric Research last year showed a 25% response rate for those who had antidepressants and manual-driven psychotherapy (mostly CBT), no better than antidepressants alone. This compares with a 31% response rate in those given a placebo in other studies.

Proper translation of the benefits of treatments identified in randomised controlled trials cannot be done on the cheap. It requires rigorous reliable assessments and a commitment to fidelity. But the latter has to be accompanied by the flexibility of adaptation to the individual. Respect and reverence of patients’ perspectives are paramount. Without funding bodies going beyond operational matters of numbers/waiting times and focussing on real world outcomes, the promise of randomised controlled trials will not be realised. There is a pressing need to return to basics by measuring treatment effects in the real-world.

In practice, there is also unfettered discretion when it comes to a clinician’s choice of which client problems to tackle, in what order and with what evidence-based protocol.

It is, however, possible for individual therapists to deliver quality therapy. I have outlined the specifics of this in Personalising Trauma Treatment: Reframing and Reimagining. I have termed this “restorative CBT”—returning the person to their old self. In this work, the uniqueness of the individual is recognised (e.g., “what does the trauma mean to you today?”), yet at the same time commonalities are recognised, such as the state of “terrified surprise” (a combination of exaggerated startle response and hypervigilance) experienced by those most debilitated by trauma.

Unfettered Discretion on Outcome Measures

In their important book Noise, published last year, Kahneman et al highlight the poor levels of agreement on matters as diverse as judicial sentencing and psychiatric diagnosis. Such disparities are clearly unfair.  But there is also heterogeneity of outcome measures. This makes it possible for authors to claim positive benefits in the absence of any real-world demonstration of effectiveness. Researchers have had a field day with unfettered discretion on outcome measures, facilitating the quest for positive findings and heightening the likelihood of publication.

Clients have a right to expect that primary outcome measures should be meaningful to them. The danger is that because of a power imbalance, clients defer to the conclusions of the professionals on outcome and, in Kahneman et al’s terms, a “respect-expert” heuristic (rule of thumb) comes into play. As a consequence, the client is likely to be continually short-changed.


Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.


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  1. The real world outcomes are very bad. But even if that were not the case, we must eradicate the entire Mental Health System.

    I say this as California Governor Gavin Newsom is on the verge of getting his Psychiatric Internment bill passed.

    A central figure behind this is Sacramento Mayor Darrell Steinberg, who put his daughter into psychiatric internment at the age of 13.


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    • How horrible. I would guess that the plight of the mayor’s daughter is a sealed matter. We need a national focus on how children are betrayed by the medical system and end up institutionalized. Families need better information on prevention of illness, the anti-inflammatory lifestyle, the practice of functional medicine, emotional education for families, and changes in the Food and Drug Administration. My heart breaks for children who are exploited by allopathic psychiatry.

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  2. Personally, I found psychologists – one of whom I made the mistake of hiring, and another who attempted to trick me into hiring him – to be pathological liars, incorrectly assuming asses, and the most disrespectful people I’ve ever met.

    Perhaps some ethics classes and an education into how to treat others in a mutually respectful manner are needed by the “mental health professionals”?

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    • Yes, so much in the “helping” system is geared towards strenghtening and pandering to the “professional”‘s power, and so little towards how to treat other poeple right, which is kind of a baffling shortcoming.
      The system does not even have the the basis right, and wants to pontificate about what is mad and what is not …

      ‘incorrectly assuming asses’ is the most sprawling specimen in the mental health profession.

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  3. There was an old study done in Washington state, several years old now, that tried to assess the effectiveness of various mental health interventions.

    Its outcomes included things like “was unemployable, now employable” or “was addicted, no longer addicted.” By outcomes of this type, the mental health interventions utterly failed. I don’t think this was a controlled study. But I don’t think it showed any real difference between intervening and leaving the person alone.

    The problem is that when many personal problems go too far south, there is a demand from the person themself or their family or the community to “do something!” Underneath all that is a demand from many governments to use “mental illness” as a way to deal with their political enemies. With these various pressures on the system, along with its obvious ignorance of its subject, we get the results as mentioned above: NO RESULTS, or negative results.

    Though my colleagues don’t normally treat psychotics, we totally depend on the person’s own opinion of whether or not they are getting better. We do a metered test just to make sure, but even if that is a “pass” if the person themselves does not express total happiness with their treatment, something went wrong.

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  4. To be fair, it’s messy and isn’t necessarily the point, in fact/ It might be the point of whether to conduct an intervention or which one and so on, but attempting to evaluate something asserted to be biomedical doesn’t necessarily have to take into account success.

    If it really was like insulin and diabetes, with valid measures and everything else, then focusing on them wouldn’t be the big picture, but it would have a place.

    The problem, of course, is that it isn’t insulin or diabetes and the measures aren’t valid. So the crux of the problem is that it’s contrived and less than meaningless.

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  5. I am waiting for my laundry to dry so am not focussed but I have always found any therapy rather magical.

    The flip side of all things “magical” seems fussily fetishistic. Like when those street clowns tie sausage balloons into never endingly contorted farm creatures or dragons. The never endingly finicky procedure takes forever and pops the illusion of the magic trick…voilla! Or conversely the magic stroke is a stroke of good fortune all over in a nanosecond yet you do not feel healed at all. The procedure was too fast to do anything but reduce the balloon to a shrivelled goodbye. No cure was found.

    So at times I have enjoyed a magical session with a therapist and at other times have stood back as their magical placebo offering high hopes delves into puzzles like methods and theories and games, all quite reminiscent of a pecadillo or a kink. I never minded when the magical veil lifted on the performance and I could see back stage the manouevers, the levers and dials and knots and fixtures that appeared like fixations of the therapist, fondly held beliefs that their new healing method would not only heal me but them also, by transforming them from average healer to magestic healer…what a buzz!

    I do not find that outrageous. Most healing is relational. It is not about the snake oil but the confident greeting handshake at the door. That is where the “placebo lift” rises aloft like a let go party balloon.

    I have always loved Gestalt therapy because self honesty is one of its foundational principles. Its therapists have to tell you when they are being a crook. I find Gestalt therapists are mostly the hippies or even at moments the gangsters of party balloon meddling. They do not hide their contradictions but have them as teasers glaringly out in the open. This can be useful in a role play form of healing, in my opinion that is one of the best and most ancient forms of healing. Tribal shamans don masks to “be” the spirit of the person who brings friction to your contented existence. To make you react healthily. It is done in the spirit of play or theatre, again in powerful healing transformative rites of passage. But Gestalt therapy is not for those of a polite or delicate constitution. It can be challenging.

    CBT may be just perfect as a healing for others. Choice matters. We are all different.

    I’m bored now. I am bored with my own comment. It has fizzled out.

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  6. Actually, I am not sure if there is even a consensus about what outcomes they are looking for… In the first place, if for instance, you ask ten people what their idea of success, is, you will very probably get ten different responses. I have been in therapy and sometimes, the therapist asks what I would like to get out of the therapy, but the way most therapy is set up, it is usually forgotten, even when they use some sort of “indivualized plan.” No matter the therapy or the drugs utilized when the person stops the treatment, the person will return to who they really are. The idea that drugs and therapy can change a person is like a sad myth. For one thing, if change is to occur, it must come come from within. Drugs and therapy are from the outside. But, then, there are a million things within each of us that can only be temporarily changed at best. Although, I applaud anyone who can overcome challenges and succeed despite the odds (and that is almost everyone) each person and society at large must acknowledge that many of our weaknesses are not meant to be changed, as that would change our strengths. This would change our purpose in the world and our contract with the Creator is to what and why we are here on Earth at this time. I should say that I am talking about most people. I do not include those consumed by evil. Thank you.

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      • Can we conceive of microimprovements? Like water can ultimately carve a beautiful polished bowl in rough stone… drip by drip by drip?

        And I would also say that many who duck under the awning of therapy’s marquee arrive “lost”. They do not know what success they want, they just want to escape the way their mind inflicts painful criticisms on them. But often when we are “lost” we are our better selves. The ego cannot go to town on “lost”. I have never had more friends than when I have been “lost”. A “lost” person cannot give smart Alec answers. A “lost” person cannot judge your failure. A “lost” person is sweet in the way children can be. All in all my “lost” times has me successful. A wise therapist will recognize that “improvement” and not try to “fix” it all to the point where you look successfully petrified by perfection.

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          • I am going to snarl at my own comment like a kid jumps on their own cardboard box collage. I say a wise therapist does not “fix” the “lost”, since being lost is often our manifesting our captive inner child and as such this freeing lostness is our “finding” our “emotional” depths…but I do feel that therapy does “fix” the primate need for cossetting and consolation and comfort “whilst” we are getting used to being illogical and frighteningly but beautufully “emotional”. It is not that being logical is wrong. It is one half of human balance. But society uses regulations cooked up by its over emphasis on logic to dismiss and even reject more emotional responses that appear not to make logical “sense”. Anyways, I do think that therapy does “fix” a great deal, as any human relationship can be the life saving salvation for a lonely person and loneliness is the most virulent pandemics of our modern species.

            I suppose what I meant is that “theories” overly emphasised in that therapeutic bond can reintroduce critical over emphasis on mind monitoring, as is the trait of the overly analytical and overly logical society. So that kind of therapy can replace the warmth of the human huddling relationship that is so good at “fixing” existential loneliness, with a bored barren excercise in complex logical thinking. Though this can be soothing to the nervously “lost” who do not like the overwhelm of emotions from the inner child, and are at pains to push down a numbing depressive lid on such noise and sit in a silent session checking a watch and wondering at the financial cost.

            That’s okay too, logical sessions are just the ticket for some. Free choice is what matters. Not everyone wants to “emote” or have a boogie bear hug with a therapist. Some humans are solemn by nature. Solemn is not a problem to be “fixed”. Solemn may neither mean “lost” nor “lonely”.

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      • That gets to the fundamental difference between psychiatry and the rest of medicine. They do not use the scientific method and instead rely on subjective self report or observational data. The problem is compounded by other physicians not acknowledging this fundamental flaw.

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        • Most hospitals that are not psychiatric ones DO rely on observation and self reporting of physical pain though. And since the experience of physical pain is made worse by abject misery of a psychological sort, such as an impoverished mom having painful contractions in labor, so even in an ordinary hospital it becomes important to factor in psychological states into the way physical pain is experienced and gets soothed. Psychiatry did not invent the use of self reporting. Holistic herbalists are often turned to in desperation because they LOVE our self reporting of our aches and pains and emotional turmoils.

          Perhaps what you mean us that psychiatry “does” peculiar and unnecessarily pompous chicanary or wizardry with “what” we self report. But the placebo upliftment never leaves the ground if a doctor does not convey that he or she has ALL the answers, and products. The hubris from this has inadvertantly allowed bullying to infiltrate the logical paradigm of psychiatry and profess that the self reporting patient is too emotional to “know” themselves “logically”.

          But THIS pompous know-it-all “certainty about everyone” is destined to be a hubris from a mission creep that steals into ANY PARADIGM in our bullying logical society. It could even steal into antipsychiatry if it loses its emotional “heart” to too much defensive posturing with trading insults across the parapet with the same rational bickering reason.

          Antipsychiatry does not need to answer logic with anything but the trobbing beating broken heart of LOVE.

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  7. I say that you’re not going to have affective treatments when you don’t understand the problem you’re treating. When I was in psychological distress people would push medication or therapy. I know they thought that I was just too untrusting or have an extreme need to handle it myself or just afraid of stigma etc. But none of those were the reason I didn’t go to the mental health system for help. I was very very desperate. If I had thought for one second that the mental health system could/would help vs. giving me more to deal with, I would have been pounding at the door. However, my psychological problem itself pointed out to me how ignorant psychiatry/psychology really is. The medical model was obviously untrue but that isn’t close to all the inaccurate theories. I’m yet to see a theory/model without something of significance, that I can say with a lot of certainty, is inaccurate. One example, I look some websites that therapists write into. They talk about dealing with a client’s anger. If I ask why do you think the anger is so intense, and I get no response or their temperament and/or upbringing. Before my problem, I didn’t know myself why some people’s anger was so intense. But the trauma I experienced resulted in a change in the intensity in emotion I felt that was massive. It was very clear that the change was due to the experience not my innate temperament or upbringing. But if you believe it’s temperament or upbringing, you’re not going to look at what happen, nor are you going to provide validation on how one of the impacts was increased intensity in emotion. You’re not going to view the increased intensity of emotion as the fault of the experience instead of the client. You won’t give validation on how difficult it is to be living with very intense emotion. Such validations can be calming. Instead it’s send the client to DBT or Anger Management Classes that can add to anger. At least it would mine. Now I feel anger at less an intensity than I did before the trauma because I worked through stuff from childhood in addition to the trauma. How more obvious can it be that trauma affect intensity of emotion?

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  8. Funny, but they had the same trouble with the identification and treatment of ‘witches’.

    In the end I suppose it’s an individual thing, and leaving it to the experts to devise ‘tests’ would seem to result in a bunch of people driving themselves insane, and having exclusive conferences where they demonstrate the levels of their insanity to each other.

    All the while good witches are dying whilst hoping for the promised breakthrough.

    As someone who was diagnosed with a serious mental illness by a Community Nurse as a result of a phone call between him and my wife, later to be undiagnosed by a consultant psychiatrist after I had been delivered by police for treatment of the illness I was diagnosed with by the Nurse over the phone, I find all this diagnosing and undiagnosing confusing.

    One minute I have it, and then a few hours later it’s gone. Might it have had to do with the need to have an ‘illness’ to conceal the crimes the Community Nurse was committing? Can he really make me an “Outpatient” of his hospital as a result of a phone call from a bus driver who has ‘spiked’ me with date rape drugs, and would like me subjected to an ‘acute stress reaction’ by police to force me to talk?

    And my what a ‘weapon’ when you consider the uses this can be put to by making any citizen into an “Outpatient” with zero accountability, and then being able to have police beat them into confessions, while the mental health professional watches proceedings, labelling the resulting behaviours an ‘illness’. (see the quote from the Chief Psychiatrist stating that the observable behaviours are what matters, the beatings and forced covert drugging’s are just the ‘patient’ offering “justifiable explanations” for the behaviour, and do not matter in the “clinical picture”. Meaning it is simply a matter of torturing citizens and the resulting behaviour can then justify their ‘treatment’. And this guy is our Chief Psychiatrist?)

    And I can give the verbatim quote if you like but what he is saying is that this man;

    would be offering “justifiable explanations” for the illness he was diagnosed with as a result of the way he was ‘treated’. He was actng like a nut after they beat him up, so he does have an ‘illness’ right? His chemicals are unbalanced now. Forget about the “concerning aspects” of his detention, he needed treatment, shown by his “observable behaviours”.

    Personally I don’t think he would have behaved in the manner he did, nor require putting into an induced coma (Chemically koshed at the E.D. to allow the legal narrative to be sorted out before he was allowed access to any legal representation) if it wasn’t for police running him down with a motor vehicle, and then stomping on his head with their boots. Just a matter of where to “edit” the legal narrative and start with the story you want to determine your outcome. In my case, the Chief Psychiatrist didn’t like the law so he rewrote it, and started with me being an “Outpatient” before the Community Nurse left the hospital, with police believing I was a ‘mental patient’ in possession of a knife he had arranged to have planted on me when I had collapsed from the ‘spiking’ with benzos..

    Oh….. and someone send police out to my home to retrieve the documents proving what i’m saying would they please? It wouldn’t look good someone having the proof of the uttering with the forged documents produced to conceal human rights abuses. The community might realise what is REALLY going on in these places over the barbed wire fences.

    Not a lot new under the sun

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  9. IAPT is already horribly medicalised, decontextualising and generally frames distress in terms of ‘symptoms’ ‘disorders’ ‘treatment’s etc. I think I would have to leave if this was further cemented by adopting structured interviews to then subjectively apply some disorder label and then some ‘disorder specific’ model.

    As if we can just take treatments off a shelf and apply them to people as if they are broken records. CBT makes the assumption that the world is okay and the problem lies within your disordered thinking, behaviours and attitudes. The world is acknowledged but is then reduced to a mere trigger again for your own personal disorder. It then attempts to adjust people to what are really myriad cultural disorders – It also fails to do this just like most therapy fails and can be harmful. Read William M Epstein’s books for a take down of the research literature. The Illusion of Psychotherapy, Psychotherapy as Religion and Psychotherapy and the social clinic soothing fictions.

    What impact does this have on the culture at large and people’s thinking? Does it give people the idea that they can just apply some technique or simply sift the data, think rationally and be different to how they have been, probably for most of their lives?

    The illusion of the quick fix and radical individual transformation is everywhere – We also seem to be losing the ability to think of ourselves outside of medicalised language, we’re all mentally ill now it seems.

    This also seems to be useful for power because it de-contextualises and depoliticises distress.Why bother making the world fit for human thriving when its all between your ears.

    Most IAPT services offer almost nothing and once you subtract the time for endless box ticking and empty notions of ‘recovery’ you get low CBT is 3 hours, intermediate CBT 5 hours and high intensity 8 hours.

    In my experience most people in these services are just incapable or unable to think critically about this multi billion pound monster – seems we are back to the cultural disorder of self interest.

    and then what of free will not not?

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    • If this article has caused you any concerns call NoLifeline on 1800 eat shit.

      Seriously though, you make a good point with your questions

      “What impact does this have on the culture at large and people’s thinking? Does it give people the idea that they can just apply some technique or simply sift the data, think rationally and be different to how they have been, probably for most of their lives?

      The illusion of the quick fix and radical individual transformation is everywhere – We also seem to be losing the ability to think of ourselves outside of medicalised language, we’re all mentally ill now it seems.

      This also seems to be useful for power because it de-contextualises and depoliticises distress.Why bother making the world fit for human thriving when its all between your ears.”

      The mass herding of people into ‘mental health services’ seems to be a stage of progression with National Socialism. This is no mean feat to take people from thinking about those few people who have some serious biologically based mental issues (the “mentally ill”), to having them think of their fellow citizens as being one step away from a mass shooting.

      The rise of the politics of fear.

      With this shift there needs to be a mechanism for screening large numbers of people for processing. Ensuring that when it goes wrong, that it becomes justification for the removal of more rights, and more money to be put into ‘research’ (Ever see a kid benefit from the large amounts of money going into childhood cancer research? I know I’ve seen the nice cars being bought with the money, but the kids don’t have licenses to drive them).

      “we’re all mentally ill now it seems.”

      In fact, in Australia this is a true statement, our Chief Psychiatrist has made anyone who isn’t an “Inpatient” into an “Outpatient”. We have all had our rights removed and they can simply call police and have us arbitrarily detained at any time, and delivered for the ‘treatments’, no right to consent or bodily autonomy.

      Sounds crazy I know, and well, the people who have looked had to unlook. No point making noise when you can be ‘assisted’ to voluntarily die, and the legal narrative “edited” by the State for convenience. So much for the protections afforded by the law that our politicians (who need to work with the corrupt networks which are forming) so often boast about. Those “added protections” who they never identify the beneficiaries of to the community.

      The “concerning aspects” of this detention requiring “added protections” for those doing the ‘detaining’ for mental health services. And the quid pro quo in the ‘induced coma’ while the legal narrative is “edited” (and witnesses threatened) ensuring that politicians aren’t lying to us when we are told “there are added protections”.

      And who is going to stand up and provide legal services to this man, instead of turning a blind eye and throwing him under a bus when the media no longer gets any clicks from the matter?

      It’s quite clever, and highly effective, relying on psychological techniques used by the National Socialists all those years ago. In fact, there is a myth in this country that people have a right to confidentiality (easily proven false). The methods being employed are the exploitation of trust, necessary in the war against the people who elect our politicians.

      The medical fraternity providing information which is offered to them (but would be denied to police) to ‘authorities’ as a means of breaking down resistance (see Franz Fanon Wretched of the Earth for the method used by lawyers and psychiatrists to have their ‘clients’ sent ot the guillotine in Algeria). And in fact, given no means to make a complaint regarding your ‘treatment’ those who are presented with opportunities to extract information using the more aggressive coercive techniques, would do well to take them. And I note the screams that haunted the torturers seeking help from Fanon. has been removed by sedating the victims first. “added protections” ….. for those administering the treatments, not so much for those on the receiving end. Though I’m sure the community appreciates the “added protections”.

      Money from snake oil, and power in the form of the dismantling of the rights paid for in blood by our forefathers (and mothers in some instances) with a pen.

      “suspect on reasonable grounds that the person be made an INVOLUNTARY PATIENT” (with Criteria set out plainly in the Mental Health Act as to who this is referring to, and an offence punishable by prison to NOT meet those criteria) becomes “need only ‘suspect’ that the person requires examination by a psychiatrist” (which is NOT set out in the Mental Health Act, and which are commonly called human rights abuses and ‘suss laws’).

      Now this misrepresentation was written by our Chief psychiatrist, the person who gives “expert legal advice to the Minister” and who is charged with protecting “consumers, carers and the community”, and yet he isn’t aware of the protections he should be affording? Isn’t aware he doesn’t actually have the power to rewrite our laws without Parliamentary approval?

      Even Himmler had to ask Hitler to have the laws changed after Josef Hartinger pointed out the ‘little issue’ with the political killings being done at Dachau. Imagine the problem for the State when the United Nations made it clear that the State IS responsible for crimes committed by public officers? (Corrina Horvath) No washing your hands of them as being bad apples now, and enacting “added protections” that the ‘public’ wants (based on a opinions of our ‘elected representatives’, though don’t tell the public before an election what they want).

      If this were the case they should have passed laws brining back executions, as most of the public wants that more than euthanasia laws. Though with the “editing” of legal narrative being allowed by the State is it really necessary when it could be done in facilities other than prisons?

      And do you think I can get a lawyer to take a look at what the State calls “editing”? Mind you, no one really wants the Shutzstaffel breaking down your door to retrieve documents that would be an embarrassment showing that human rights abuses are being “edited” out of legal narratives before being provided to the ‘legal representatives’ of victims of those abuses. Think the situation with Lawyer X/Nicola Gobbo was bad? You should see what is being done with the marriage of police and mental health services in this State. Though they do have the “added protection” of it not being torture if it is “inherent in or incidental to lawful sanction”.

      And I note our government needed to follow suit from Himmlers diaries, and pass Euthanasia Laws. No discussion in the lead up to the election, we were simply told that 87% of the public wants these laws (and they refused to release the proof of this statement). The laws bulldozed through, and police dug up the wrong corpse to ensure that the laws could be applied retrospectively.

      So what impact does it have on a culture? I look forward to seeing the progression into full scale fascism. I’m sure this time they will get it right.

      To paraphrase a famous Jewish political commentator ‘Not only does the population not know what’s going on, they don’t even know they don’t know what’s going on’ Simply walking into the showers thinking “they wouldn’t do that, the rumors’ can’t be true”. If I had a dollar for every time I’d heard that rock solid defense.

      Look away people, it will never happen to you or your loved ones. You have the “added protections”. The same ones afforded Japanese Americans in 1940.

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  10. Excellent insights. My eyes lit up when I read, “Whether therapists or psychiatrists, researchers and clinicians have looked predominantly at symptom reduction, rather than whether treatment has provided added value to the client’s life. And all of this is usually rated by the clinician—rarely do we ask clients what they think about the treatment.” This is the crux of the matter, yet we feel an obligation to be conversant with all the other constructs that the mental health system expects us to respect and value, in order for us to get our foot in the door to convince the system of what they really should value, i.e, the consumer’s satisfaction and well-being.

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  11. Hi Topher
    for over 30 years I have seamlessly woven a standardised semi-structured interview into my conversations with clients, none have ever voiced concerns over my assessment. The results of the assessment have highlighted particular treatment directions, in the style of my recent book Personalising Trauma Treatment. No one has ever said it is in anyway robotic and its a million miles away from IAPT’s fundamentalist translation of CBT.Try it as per my recent offering and see how it goes.
    I really do sympathise with your having to endure IAPT, have a look at the recent blog of a PWP on it is truly ghsastly

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    • Hi Mike,

      I wonder if we would expect people to question an assessment done by someone in a powerful position no doubt presenting what they/we do as evidenced based? all legitimised by therapies broader context in terms of its cultural position and sanctioning?

      In my experience people are desperate for any sort of help. I’d say one of the most common responses from people about past therapy is that it was helpful at the time.

      When pressed people often suggest it was helpful to be able to talk about things or have someone listen. Some might be able to half remember some technique but there current situation is one of great suffering.

      Yet when you look back at the notes you would think a major successful treatment has been carried out.

      We know from the common factors material that the most important element in any successful therapy is nothing to do with therapy, its all about the persons resources, the the relationship then some idea of shared goals and placebo trumping much of this. Then if you read critics like William M Epstein he pulls apart of the best of the evidence and states none of it has any evidence and it can be harmful. It also does’t seem to matter about training or supervision lay people with compassion have been shown to be no different from the eminently qualified.

      Surely in reality there are few people with adequate resources enabling them a freedom of change unavailable to most people?. Is it not cruel then to blankety offer therapy to anyone when for most it is the suffocation of limited resources and systemic cultural disorders that are causing so much distress?

      you might find this ladies work useful around IAPT

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  12. Michael Scott, I apologize if my wit was taken to heart. I am a court jester. I think CBT suffers from its title. Cognitive then behavioural then therapy. Really I see it more as a Buddhist focus on the chattering monkey and a focus on how to reign in destructive thinking. As such it is like a mystical discipline that a monk might try to teach in an ashram or commune of enlightenment-seeking people. But the mechanistic title is kind of boring.

    Gestalt therapy as a title sounds delightfully chaotic.

    Jungian therapy sounds visionary.

    Humanistic therapy sounds sci-fi.

    Rogerian therapy sounds like a bounding dog called Roger leaping across a muddy puddle to befriend anyone.

    The overly logical title that CBT has seems to eschew feelings in favour of yet more dull excersizes in thoughts or mind control. Which is a pity. It is a shame because I know that pesky runaway catastrophic inner preoccupied thinking is at the centre of so many human discontents. Maybe invent a version of CBT that uses a brand new name. Caring Best Therapy. Centering Being Therapy.

    I must go now.

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