[naasking]

> but there are obviously people who are not career athletes that don't have a defined stop point with employing a trainer

And many of them are being bilked as well. The fitness industry is notoriously filled with hucksters and scams, and "trainers" rarely have any real training in kinesiology or exercise science.

> I'm curious, it's considered the norm to regularly see a doctor or dentist, do you think they're preying on their patients?

Once a year for a health checkup. Is that the norm for therapy?

> Mental health. There's obviously a more involved answer

The more involved answer is that "mental health" is not well-defined, so it's not developing anything. The only therapies that have shown to have any empirical validity, like CBT, train the user in tools to change their own behaviour and thinking, then it's on the user to employ the tools. Does a family doctor call you in once a week and watch you take the pills that address your physical ailment?

The best analogy for psychiatric therapy is physical therapy for recovering from an injury or surgery, except physical therapy has a well-defined end condition, which is when you understand how to do the exercises yourself. Then it's on you to do them. This is just not the norm for "mental health" therapy.

[sdwr]

Nail on the head, thanks. I'm deeply uncomfortable with anything that combines paying for a service with a social element. Feels like an unstable equilibrium.

I guess the skill is riding the line, but that doesn't feel very enjoyable.

[cbsmith]

> I'm deeply uncomfortable with anything that combines paying for a service with a social element.

I think I don't know what you mean by that. That sounds like you're uncomfortable with renting out party venues.

[cbsmith]

> And many of them are being bilked as well. The fitness industry is notoriously filled with hucksters and scams, and "trainers" rarely have any real training in kinesiology or exercise science.

Many people are being bilked for almost any service one might name. There are tons of products and services with no defined stop point (heck, pretty much the entire CPG category is for products and services with no defined stop point). There are tons of products & services where the vast majority of customers are unable to discern if they are being scammed or not. Heck, when you order sushi there's notoriously a far from trivial chance that you're not getting the fish that you thought you were getting. We don't think of restaurateurs as being hucksters and scam artists (some no doubt are, but it's ridiculous to paint them all with the same brush).

My point isn't that it's impossible that they are being bilked. It's that there are all kinds of products & services that people get with no defined stop point, where customers could unknowingly be scammed, but we don't consider that to be evidence that they are being bilked. There are products and services that are beneficial for the customer even if there is no defined problem and no defined end point.

For your typical customer, spinning class isn't a class you go to until you achieve some goal. It's a service provided to help you do exercise you no doubt wanted to do anyway, in a community/context that you wanted to do it in, with the guidance of someone who ostensibly knows how to structure the process better than you do. You could very well do the spinning all by yourself, or you could organize a spinning class on your own, but you pay the professional because you expect to get better results without expending as much time or energy yourself.

Sure, there are people who claim that, if you just take the spin class, you will lose 100 lbs or become an Olympic athlete, and those people are absolutely hucksters and scam artists. There are people that will tell you that voting for the right/wrong politician will change your life (either for the better or worse). There are people who will tell you that buying gold will ensure financial security and make you a fortune. There are scams about buying jewelry. There are investment funds that claim to be able to consistently beat the market, or that will protect your money through any market collapse... and in all those cases there's no defined stop point. The product is the prop, not the scam. Sure, in the context of the scam the prop isn't worth it, but that doesn't mean anyone offering the prop is scamming you. Physical training services, votes, gold, jewelry, investment funds, etc. aren't all bunk.

> Once a year for a health checkup. Is that the norm for therapy?

So now it's the frequency that's the issue, rather than not having a defined stop point?

> The more involved answer is that "mental health" is not well-defined, so it's not developing anything.

That's your answer. That's not my answer, and it's not the answer.

> The best analogy for psychiatric therapy is physical therapy for recovering from an injury or surgery, except physical therapy has a well-defined end condition, which is when you understand how to do the exercises yourself.

I don't think you appreciate how limited your perspective on this is. Not everything is a problem that can be fixed.

This presumes that the only possible physical therapy service is education. My mother suffers from late-stage dementia. She is at risk for falling whenever she walks, and performing more involved physical activities absolutely requires guidance. It is literally impossible to educate her out of this situation, so the only stop point for the service is death. While family does sometimes provide these services for her, there's little doubt that the professionals we hire to provide these services for her are able to do the job better and more consistently than we can; there's little doubt that she is physically and mentally healthier as a consequence of their services, and that her physical & mental health would begin to decline within days of terminating those services. Now, I don't know that their particular form of physical therapy is empirically valid, and I guess they could be scamming us, but in the vast majority of cases, providing these services is not a scam. It's offensive to claim otherwise.

Now, my sister-in-law has the reverse situation: she has a physical problem and requires mental health services. She suffers from COPD that will kill her unless something else gets to her first. Above and beyond the physical condition, it is very hard for her to cope with it mentally. Again, family provides her with support, but it's not enough. She employs a mental health therapist to address her anxiety, depression and suicidal ideation. There's maybe some feint hope that the therapist will educate her to a state where she no longer experiences suicidal ideation, but nobody expects the anxiety & depression to go away, because COPD is an anxiety and depression invoking condition... a well educated, rational, COPD patient can be anxious and depressed. You could say that, with or without professional service, the failure rate is nearly 100% (helpful to consider in the context of comments about the failure rate for mental health therapy). So there's no defined stopping point for the therapy short of death. In this particular case, it's a CBT therapist, but even if it wasn't, what she needs is more than education; she needs support. While we can't rule out that she's being scammed, in the vast majority of the cases, providing these services is not a scam. It's offensive to claim otherwise.

> The more involved answer is that "mental health" is not well-defined, so it's not developing anything.

I'll try one last metaphor:

Nutrition is not well defined. We have broad ideas about what is and isn't good for you, but the specifics of what is "good nutrition" are variable & contextual; while one can have well defined nutritional goals, many people do not. There's a ton of "nutritionists" who have no formal training, who don't exercise science. There are short order cooks with no formal training, who don't exercise science. If a grocer has formal training, it is far more likely in business or marketing than anything involving nutrition. There is no defined stop point where you no longer need food. There are plenty of scams involving nutritional guidance or foods (just the categories "health food" and "diet plans" are littered with scammers). Despite all that, there is no compelling argument that restaurants, chefs, grocers, or other nutritional services are intrinsically scammers. I'm pretty sure that, if I don't eat, my health will deteriorate, and I have a hard time believing that a professional either guiding my nutritional choices or outright providing nutrition for me is intrinsically scamming me. They could well be providing me a valuable service where I get better nutrition with less time and effort than if I tended to it without them.

I get it. You are convinced therapy is intrinsically a scam, and part of the reason for that is most customers for therapy cannot reliably discern if they are being scammed or not. I'm far from an expert on the subject, so for all I know, you are right. However, the arguments you are presenting are not compelling arguments.

[naasking]

> So now it's the frequency that's the issue, rather than not having a defined stop point?

You have a physical problem, you go to the doctor and he fixes the problem or gets you the information you need to manage your problem. That's the stop point for medical intervention.

You have a mental health problem, you go to a therapist for a mental health intervention, and now you're in weekly therapy for years. Not so much an intervention, more like a new part time job.

Yearly checkups is not a counterpoint to this general trend. A yearly mental health checkup could be totally reasonable, but that's not the norm.

> Not everything is a problem that can be fixed.

The real issue here is that you keep bringing up outliers like your mother's palliative care and I keep talking about the norm, ie. that most people in therapy are not like your mother. Therapy has become fashionable. Everyone is "working on themselves" and plenty of therapists like patients that are well off and so can pay regularly.

> I get it. You are convinced therapy is intrinsically a scam

No, that's not the point I'm making. At best, you could maybe case what I'm saying as "the therapy industry/fad is a scam, and plenty of therapists, psychologists and psychiatrists are feeding into it".

There are people that legitimately need therapy to develop coping strategies to address trauma or retrain maladaptive behaviours, because even as ineffective as it sometimes is, it's better than nothing. My point is that a lot of people who go to therapy probably don't need therapy, and even if they do they don't need as much as they think they do, the techniques in therapy are not very effective even in the best case, and that therapists are not incentivized to stop seeing patients that are paying them well and triage to cases that need more urgent intervention and probably can't pay them regularly.

Part of this is probably because of the US's dysfunctional medical system, and another part is because psychology and psychiatry has not had a good track record for empirically sound practices. It's getting better but has some ways to go.

[cbsmith]

> The real issue here is that you keep bringing up outliers like your mother's palliative care and I keep talking about the norm, ie. that most people in therapy are not like your mother.

So, if the customer is dying (and we're all dying), it's not a scam, but if the same service is provided to someone else, it's a scam? That almost sounds like, (...wait for it...), the service isn't the scam.

> Therapy has become fashionable.

Nothing worse than services that have become fashionable.

> Everyone is "working on themselves" and plenty of therapists like patients that are well off and so can pay regularly.

Nothing quite like customers who can afford to pay for your services. Mercedes dealers tend to focus on those people too. ;-) Is it your position then that services that only wealthier people can afford are a scam? Is it not possible that they're receiving some benefit from the service that others would benefit from if they could somehow afford them?

> My point is that a lot of people who go to therapy probably don't need therapy, and even if they do they don't need as much as they think they do, the techniques in therapy are not very effective even in the best case, and that therapists are not incentivized to stop seeing patients that are paying them well and triage to cases that need more urgent intervention and probably can't pay them regularly.

Ice cream is similarly a scam, because a lot of people don't need ice cream, but they think they do. The ice cream is not very effective for them even in the best case, and ice cream makers are not incentivized to stop selling it to people who don't need it.