[epmaybe]

If you think this is bad, wait till you hear about [insert field of medicine here]!

In all seriousness, fraud is rampant, and cash pay or low regulation fields like dentistry can easily take advantage of patients and their health literacy.

In ophthalmology, you hear of “laser” cataract surgery, “floaterectomies”, telling patients they need cataract surgery well before they are symptomatic, dry eye treatments.

Hell, in cardiology there have been multiple cases of fraud uncovered where doctors were putting pacemakers and defibrillators in people that didn’t even need them!

Maybe I’m jaded, but when there exists such a profit incentive, we as healthcare providers struggle to “do no harm”. I’m lucky to be surrounded by mentors and other doctors that try and exemplify the moral behavior patients expect in healthcare, but imagine if I had a mentor early on like Dr Lund in the article..

[bigmattystyles]

I am especially skeptical of offerings that deal with therapy and the massive advertising campaign some companies like betterhelp. Improvement from therapy is not something that’s easily measurable and I’ve know a few therapists (not psychologists) and their coursework from reputable universities absolutely shocked me in its lack of scientific rigor. I have no doubt there are wonderful and competent folks working at online therapy shops, and I have benefited tremendously from an in person psychologist and everyone benefits from mental health resources being available, but online therapy and the therapists and the bit I know about their studies scares me.

[jodrellblank]

> "Improvement from therapy is not something that’s easily measurable"

Is it not? I have commented before about the work of Dr David Burns[1], and one thing he drills over and over is that therapists need to start measuring their work, and it is easy, and they don't because they either don't want to hear that they are doing a bad job or they depend on their clients for long term income and so aren't incentivised to want improvement. He endorses a mood survey[2] which the patient/client fills in at the start and end of every session. If the patient self-reports "I feel 5/5 hopeless" and two sessions later they report "I feel 2/5 hopeless", isn't that a measurable improvment? if instead they say "I still feel 5/5 hopeless" isnt' that a measurable lack of improvment?

It isn't an objective quantification but if the reason for seeking help is self-reported bad feelings, and afterwards the bad feelings are reduced or gone, the evidence for improvement is at least as strong as the original evidence of a problem existing. And it's easy to find out if the bad feelings are reduced or gone by asking. See some examples in the podcast summary here[3] talking about studying the effectiveness of the therapy app they are working on: "two groups, including 60 participants with moderate to extremely severe depression at the start of the day, and 73 participants with no or only mild feelings of depression. [...] The reductions in depression in both groups, as well as the additional six negative feelings, were substantially greater than the reductions reported in large numbers of published outcome studies with cognitive therapy, other schools of therapy, and antidepressants. All seven types of feelings were dramatically reduced in both groups. For example, the depression reduction was 62% and 51% in the severe and mild groups, respectively, and the anger reduction was 70% and 81%, respectively"

and

"The feedback we received on the app has been largely totally unexpected. Some things that we thought were blow-away were criticized, and some parts that we thought were weak were strongly celebrated. This experience has been much like using David’s feedback scales in therapy. Therapists learn that their perceptions of how their patient feel are often not[?] off-base, and that many of your favorite techniques and strategies are not effective. This information, if processed with respect and humility, can transform your clinical practice."

[1] Dr Burns does the Feeling Good podcast ( https://feelinggood.com/list-of-feeling-good-podcasts/ ) and book, is a retired Professor from Stanford Uni, was a pioneer in Cognitive Behavioural Therapy, and now works promoting his TEAMS CBT model which has insights on how to hone in quickly on the reasons people are stuck and can't change, and then how to get past that.

[2] One of the mood surveys https://feelinggood.com/wp-content/uploads/2013/10/brief-moo...

[3] https://feelinggood.com/2022/02/28/the-feeling-good-app-part...

[dwaltrip]

Measuring psychological well-being is not easy.

With emotional dysregulation or trauma, which comes in many varieties and is more common than people realize, the path towards healing often involves someone feeling "worse" at first as they begin to face pain and emotions that have been suppressed

Someone who hasn't yet overcome their biggest difficulties won't have deep insight into their various psychological states and frames of mind. Without proper guidance, attempts to measure what's going on and assess progress can cause confusion and frustration. Especially if they aren't receiving helpful treatment, which is unfortunately far too common.

I think there is potential for measurement to help, but it's a difficult thing to do well.

This is all simply an aspect of the more general issue of how psychology and psychiatry are not well-developed areas of practice. Humanity is still learning how to effectively approach these problems.