How do you know someone has really meditated? You don’t. How do you know someone has had a good dance? You kinda don’t know that either.

There is a basis for understanding this from an engineering perspective, and it’s right there in what you just said — that outcomes are not correlated with educational background of the clinician. Sound like programming at all? Programming is also as much art as it is a science.

So therapy is no sure thing. That much, to me, is fine. And that’s the other rub. If you want to get something out of therapy, you’ll only get out as much as you get in. There can be no shortcuts blaming things you don’t like, nor idealizing the things you want to like. We can talk standards and rigor all day. But there’s no getting around having an internal compass of honesty, and a desire to apply that honesty to one’s life. That’s what a therapist (or therapy group) should be for you — an objective voice that questions your view of things while letting you be heard, as well as creating a safe environment for you to unwind the dark corners of the mind that are normally difficult to reflect upon on one’s own. Even there it is up to you to reflect on what happened afterwards. Your therapist cannot follow you all the way.

Programming isn’t art either, not because you can’t do art via programming, of course you can, art happens whenever human hands are involved in the production process, my point being that we’ve romanticized programming for too long and it’s unhealthy.

Programming has more to do with engineering and plumbing than it does with sciences and art.

Across much of the US and Canada, words like "therapist" and "psychotherapist" are unregulated titles and practices, if not claimed to count as one of the licensed professions

I know for sure that this is true at least in New York where my mother is a (licensed PhD-holding) psychologist, and in Quebec where I live now, but I think this is typical.

"Psychologist" and "psychiatrist" are of course regulated, as is "social worker," but the generic unregulated therapy terms lead to lots of underqualified people doing bad diagnosis and treatment.

Psychoanalytical Therapist is perhaps the caveat you're thinking of? I know in New York it is a regulated title, and it may be possible to practice independently without a Counselling or Social Work degree provided one isn't billing insurance or advertising as a "psychotherapist".

Psychoanalyst is a regulated title, as are certain mental health professional titles which include the words therapist or counselor as part of the title.

But neither therapist or counselor standing alone nor psychotherapist is regulated there. (Nor is psychoanalytical therapist, unless something like case law has found that to be too confusingly similar to psychoanalyst.)

I'm not disputing your examples from other states. Just saying that these titles are significantly ambiguous across North America because of their inconsistent status, and therefore there's no standard of treatment which one can assume for them without knowing the precise state or province in question.

I mean these are nice people with good intentions but so is a priest in a church or a temple. The whole thing feels half baked. Ya ya I know reprogramming the mind is complex and this is a work in progress. But my experience from work and coaching team sports is people follow authority figures when in doubt/outcomes are unknown. And most shrinks and counsellors in my case atleast are unable to establish authority.

> The CBT ppl just blink at me like the question is not on their manual.

What country? In England the IAPT programme (the main source of CBT) has extensive data collection on outcomes (probably the largest collection in the world) and a focus on getting more and better evidence to improve the service.

Chapter 3 and 6 of the IAPT manual are about evidence based practice and gathering better data:

https://www.england.nhs.uk/wp-content/uploads/2018/06/the-ia...

The data sets are here: https://digital.nhs.uk/data-and-information/publications/sta...

The latest (Jun 12 2018) says this

---begin quote---

Key Facts

In April 2018 there were:

-- 119,304 new referrals;

-- 85,145 referrals that entered treatment;

-- 47,296 referrals that finished a course of treatment, of which;

-- 89.4 per cent waited less than 6 weeks and 98.9 per cent waited less than 18 weeks to enter treatment;

-- 44,222 started their treatment at caseness, with 51.9 per cent moving to recovery.

---end quote---

There's some jargon there, but that's explained in the executive summary: https://files.digital.nhs.uk/D3/B3FC5F/iapt-month-apr-2018-e...

tl;dr: CBT is somewhat effective; it's more effective if you have CBT that follows the high intensity model (14 to 20 weeks, one hour per week, face to face one to one with a qualified therapist).

If you continuously end up in situations where you're seeing mental health professionals, you might consider just accepting their authority without the need to jump through your hoops.

"You have to be willing to help yourself" is perilously close to "psychotherapy only works on people who are capable of changing of their own volition", which calls into question the entire purpose of psychotherapy. If I could change my way of thinking through sheer force of will, why would I pay a professional $100 an hour to sit and listen while I do it? It evokes the classic defence of the quack - the spoon only bends if you truly believe in the power of the mind.

If that problem is framed as "some patients are too sick to treat", then at least it shifts the burden of responsibility onto the therapist; it's not the patient's fault that the psychotherapist lacks the neccesary tools to facilitate change. Blaming the patient for having a bad attitude just makes the profession of psychotherapy look ineffectual.

When I went in I had some major anxiety problems, and by working with my therapist I was able to identify where those problems came from. I started taking steps to change how I lived so I wasn't as anxious anymore.

What sort of magic are you expecting from psychotherapy? You're paying someone to help you solve your problems. You're not paying someone to solve your problems for you.

On the other hand, going to therapy is forcing yourself to do something that is difficult, sometimes painful and requires a lot of effort and resources (both time and money). I don't see the relationship between voluntarily going to therapy and advertising inducing you to buy things.

A real intervention doesn’t require someone to help themselves; an appendectomy doesn’t require patient participation and motivation.

Okay, this is clearly not what we were talking about. Sorry I was not more specific in my statement to generalize to all scenarios, ever.

Edit: I think it is also a pretty fair assumption that if someone is shot or their appendix is about to burst, they would want help. The key difference here is that someone who is shot is not capable of helping themselves - with regards to many things people go to therapy for, the only way to fix your problems is going to be taking some actions yourself.

A giant % of therapists around my area advertise that their treatment methodology is "eclectic".

Trying to find someone who follows even CBT is almost impossible.

I have seen at least a few people advertising themselves as following Freudian principles. So there is that.

> Licensure is not all over the place.

The quality of programs that provides those licenses are. And thousands of hours of training under someone who is not very good, does not lead to a good practitioner.

I'm not saying all therapists are bad, but I'd say that picking a therapist at random will have about as good of luck as picking a mechanic at random: Greater odds of your wallet being emptied than your problem being fixed. Finding an honest and talented practitioner is hard.

> Studies have demonstrated that treatment outcomes are not strongly correlated with clinicians' educational background

Isn't that a huge problem?

Imagine if that was the case for any other medical profession! "The surgical techniques we teach in school, and charge a lot of money and put students deep into debt for, aren't shown to be any better than someone coming off the street with a hacksaw and a really good smile."

Now that said, I've met people entering LMHC programs who obviously didn't need the credentials, their natural understanding of people was blatantly better than what 80% of their courses would cover. But those people are the obvious exception.