“Talk Therapy Doesn’t Work”

Somehow I found myself in a conversation recently with a female acquaintance about mental health and “talk therapy”. We had previously enjoyed many friendly conversations… however, this one evolved from lighthearted topics and banter into hearing about her remarkably stressful experiences navigating the mental health system on behalf of her husband.

Becoming increasingly agitated while recounting her desperation and despair, the woman repeatedly stated that “talk therapy doesn’t work”. That’s a strong statement in light of my decades-long career as a mental health therapist. However, it sheds light on a few things, including the rush to medicate vs starting with a less invasive approach; psychiatry vs non-pharmaceutical interventions; and the role of confounding variables in treatment.

As the discussion kicked off, I observed that her husband’s retirement likely triggered obsessive catastrophic thoughts of getting cancer, which in turn triggered compulsive visits to various doctors. She identified an event when her husband was a young man in which he was told by a doctor that an injury, for which he was being treated at that time, could cause cancer later in life. She strongly agreed that he later became stuck in rumination (which I refer to as ‘stewing in your own juices’).

As her aging husband became increasingly fearful and agitated he was subjected to numerous medical tests and treatments involving medication, ECT (“shock therapy”), hospitalization, and apparently “talk therapy”. Though it’s not clear whether the ‘talk therapy’ was part of his visits to various psychiatrists. She was becoming increasingly angry and agitated, which made it difficult to extract the particulars.

The upshot is that his psychotic episodes became more frequent and more intense; he could not be dissuaded by his wife from the conviction that he was dying as ‘evidenced’ by bizarre hallucinations involving his body. She regularly reminded him of his family’s longevity and that he likely had a couple more decades. Her husband passed away last year.

When a patient is subjected to different treatments simultaneously such as medication and ‘talk therapy’ or ‘talk therapy’ and you-name-it, there are at least two interventions at play. How is it conclusive that ‘talk therapy’ is the intervention that doesn’t work?

What was the ‘talk therapy’? There are a lot of different flavors depending on education, training, experience, etc. The preponderance of potential treatments was another source of agitation and confusion for this woman. How to find what works? What are the most important criteria to apply? Is it the clinician’s advertising budget, self-promotion, smiling pictures? Is it the recommendation of others? Is it the ability to discern the likely efficacy based on accredited education, professional credentials and experience?

Delivering more than one treatment at a time creates confounding variables. It’s like throwing interventions at the wall and hoping one sticks. But which one actually stuck? Which one provided the needed results? The only way to know is to deliver one treatment at a time and carefully track the results over a reasonable amount of time. Know the target behaviors.

Hence the importance of evidence-based treatment modalities when selecting ‘talk therapy’. Do your homework and know your criteria. It’s difficult enough to discern reality in this fabricated, photo-shopped, 21^st- century AI world. Using an information / decision matrix can help sort out what’s best for you.

-Neysa