AskMeFi questioners are too often glibly told to, "talk to a therapist"

March 27, 2006 6:48 AM

AskMeFi questioners are too often glibly told to, "talk to a therapist," when asking about emotional issues. Discuss.
posted by pollystark to etiquette/policy at 6:48 AM (117 comments total)

Going to a therapist is never a bad idea. In a question regarding emotional issues, to suggest it is not silly.
posted by ThePinkSuperhero at 6:54 AM on March 27, 2006 [1 favorite]

That is too often the only useful or responsible answer that any of us could give.
posted by Zetetics at 6:57 AM on March 27, 2006

Therapists are trained to give useful, helpful, well-considered, non-harmful advice to people struggling with emotional issues. Most people on AskMe are not, and even if they were, they'd tell you that it is extremely difficult, if not impossible, to accurately judge the person's situation over the Internet and respond appropriately.

In other words, AskMe respondents tell people with emotional issues to see a therapist for exactly the same reason that they tell people with medical issues to see a doctor and people with legal issues to see a lawyer.
posted by Faint of Butt at 7:05 AM on March 27, 2006

AskMe questioners are too often told to seek professional help in every endeavor imaginable. Discuss..
posted by Chuckles at 7:06 AM on March 27, 2006

It's hard to answer questions on Askme that would really benefit from professional assistance of some kind. Moreover, some issues are simply too complex and painful to discuss on a message board.
posted by selfnoise at 7:06 AM on March 27, 2006

I think I'd need an example or two where this has been done "glibly", because I haven't seen one yet. Suggesting a therapist has, thus far, been done in sincerity, and with cause.
posted by frykitty at 7:06 AM on March 27, 2006

This is stupid. Realizing you need help and reaching out for it is by far the hardest step. However all that effort is wasted if it isn't directed toward constructive emotional work; 9 times out of 10 that necessitates the involvement of an emotion work professional.

And anyway, the vast majority of legal questions are answered with "IANAL, but go see a lawyer," and the vast majority of medical questions are answered with "IANAD, but go see a doctor."
posted by ChasFile at 7:08 AM on March 27, 2006

If you remove the subjective "glibly" I don't think there is any reason for this MeTa, even if you leave it in and the interpretation is correct I'm not sure what constructivly could become of this.

"All to often people post to MetaTalk glibly... don't discuss"
posted by edgeways at 7:16 AM on March 27, 2006

if there are people saying it glibly, I agree. If it's just an objection to the therapist suggestion one way or the other, then I disagree. I'm not even a fan of therapy, really, but that doesn't mean it isn't a valuable suggestion.
posted by shmegegge at 7:17 AM on March 27, 2006

Don't go to a professional. What do they know? It is better to trust your life to anonymous posters on the internets.
posted by caddis at 7:21 AM on March 27, 2006

I think there is plenty of reason for this thread. Repeating "get a professional" without any other information is pretty much glib 90% of the time. It is also more or less useless, because everybody already knows that.

Answers come from knowledge, not certification.
posted by Chuckles at 7:22 AM on March 27, 2006

There are at least three reasons that talking to a therapist is suggested, none of them glib as far as I can see:

1) Just enough alarming or disturbing information is provided in the original question to arouse folk's concern, but not enough is provided to really address the issues fruitfully in a response. This is not a surprise, it's an expected limitation of the medium. In this case "see a therapist" is another way of saying, "talk with someone who you can really talk to about this, notes on a message board are unlikely to cover the whole issue."

2) People have been through something similar for which they saw and were helped by a therapist.

3) The issue presented is clearly within the purview of a therapist, in the same way that a legal or medical question is within the purview of a lawyer or a doctor.

I'm not sure what "glibly" means in your objection. Therapy helps people address a variety of life stressors and mood disorders in a constructive way, it's proven effective, works fairly quickly (especially given the overwhelming nature of many of the topics it's most often used to address), and is non-invasive and completely elective (at least in the context of AskMe). For a variety of reasons people really may not think about therapy as an option when confronted with certain types of problems. Why shouldn't it be suggested?
posted by OmieWise at 7:29 AM on March 27, 2006

Answers come from knowledge, not certification.

when it comes to emotional/mental issues, i'm not sure how much of either one is going to get on the internet

i've suggested therapy on occasion ... i have never done it "glibly" ... there have been times when i haven't

and just because everyone knows that doesn't mean that everyone does that ... the asker may have considered it but wasn't sure ... but when several people advise him to, then he may decide that it's a good idea

consider this - what other alternative answers are going to be useful for certain problems? ... do people really think that they're going to solve emotional issues by asking something on the internet? ... is the problem in the answers or the questions? ... if "see a therapist" is the best answer we can come up with, how good was the question?
posted by pyramid termite at 7:34 AM on March 27, 2006

MetaTalk readers are too often glibly told to "discuss". Discuss.
posted by mr_crash_davis at 7:39 AM on March 27, 2006

I don't want to discuss it.

/harmonica solo
posted by jonmc at 7:41 AM on March 27, 2006

1) Could we get AskMe to autogenerate the first comment, which would be: "See a Therapist" or "See a Doctor" or "See a Lawyer" or "See a scatologist", depending on which category they post in.
2) Maybe some sort of boiler-plate legalese could attempt to absolve the site from all liability.
3) Maybe some sort of pop-up window could prompt the user before posting. Prompt 1: Have you checked Google? Prompt 2: Have you consulted a professional? Prompt 3: If the professional couldn't help you, what leads you to believe that a random bunch of weirdos on the internet could help you?
posted by blue_beetle at 7:46 AM on March 27, 2006

Repeating "get a professional" without any other information is pretty much glib 90% of the time.

Usually, that's not said without any other information. When I recommend it (which I have done), I give some explanation and justification and sometimes talk about my own experience, or what the poster can expect from a therapist.

It is also more or less useless, because everybody already knows that.

Everybody knows that there is such a thing as therapy. But everyone may not know that therapy is applicable to their particular problem, and may help them make improvements in their lives. They may not know that there are different kinds of therapists. They may not know that 'normal' people see therapists and that it's perfectly acceptable for them to do so.

When a poster tosses a problem out here, and several answers come back endorsing therapy, something of value has happened. Those posters learn that seeking therapy is a rational and perhaps warranted approach to solving their problem. They may also find that any sense of stigma about therapy may break down, once they've seen that many other people with whom they're acquainted (even in a slight online way) have benefitted from therapy.

This last de-stigmatizing effect is important, because so many people have mistaken ideas and fears about therapy. In some families and environments, going to a therapist is seen as a sign of weakness, or something for crazy people, when in fact it's the opposite -- it's something you do out of strength, to keep you sane.

I don't find a whole lot of glibness going on in these threads.
posted by Miko at 7:52 AM on March 27, 2006

I love when people start MeTa callouts and then don't bother responding to their own threads.
posted by antifuse at 7:55 AM on March 27, 2006

Well said, Miko.
posted by OmieWise at 8:04 AM on March 27, 2006

No.
posted by KevinSkomsvold at 8:05 AM on March 27, 2006

The problem isn't glib responses, it's stupid questions - the majority of emotional/relationship/etc. questions on AskMe are pointless froth to which the only possible answer is 'See a therapist' or, 'Talk to your friends/family/partner about it'.
posted by jack_mo at 8:07 AM on March 27, 2006

Usually, that's not said without any other information.

In the threads I read, that's exactly right. I don't remember many comments that just said "see a therapist (ha ha)."

And being told to see a therapist is very useful for many people. A surprising number of people still think therapy is for "fucking insane people that belong in a loony bin" or therapy is for "weak-will fucks that can't buckle down."

Writing "see a therapist," with the accompanying insight that is almost always given in addition, is damn fine practice. There are still lots of people that need to be reminded that therapy is not different than going to the doctor or dentist.

This thread is stupid.
posted by teece at 8:14 AM on March 27, 2006

If you read every single AskMe thread for entertainment, as some of us do, the constant "see a therapist" is a bit tedious.

But some people only go to the green when they have a serious problem and need help. For them, tedious or no, "see a therapist" may be great advice.

So what's AskMe for? Just amusing the regulars, or actually helping people who need help?
posted by nebulawindphone at 8:26 AM on March 27, 2006

The reason people say it is simple - many people will not seek professional help unless they're flat-out told that it is the correct response. I have heard problems rationalized away, friends claiming "it's not that big of a deal" about personal issues, and had people I would consider to be close go completely silent about their problems.

If you have an emotional or psychological issue, you're very often not going to seek out professional help as a first response. You're going to deny it. Anonymously posting to MeFi, or even posting by name, is the first sign that you're actually looking for help. It's fine if members of our community confirm that and point people in the right direction. Many of the posts recommending therapy are backed by personal stories or recommendations and as such help guide or even provide a plan.
posted by mikeh at 8:31 AM on March 27, 2006

How about for emotional or relationship issues we just answer "GYOBFW"? Instead of "feigning" concern by "politely" inviting someone to "consult a professional" (a fancy way of saying "fuck off" if you ask me).

A lot of these people just need a chance to frame their thoughts in the form of a question, in order to distill and reenvision their current dilemma. To this end, livejournal (or [we]blogger, etc.) would probably be very therapeutic, and allow people to cast their woes into the agora without clogging up AskMe.

Speaking of clogging up, it's good that you didn't clog up MeTa with a lot of pointless links to examples. It's too easy sometimes to point the finger and incriminate specific individuals when really, we're all to blame. It's a failing in society that people are even having these problems. Shame on us all.

Oh, and btw, pollystark? When's the last time you consulted a therapist? I think someone needs some hugs before they go pushing their scientologist agendum on us all. Maybe you should seek help?
posted by Eideteker at 8:32 AM on March 27, 2006

I hate it when people end a post with 'discuss'.

I can't really explain why it bothers me so much, but I always have this image of a prudish, 30 year old doctoral student looking down her nose at me whenever someone tells me to 'discuss'.

Please. Let us put an end to this practice.
posted by Baby_Balrog at 8:39 AM on March 27, 2006

I hate it when people end a post with 'discuss'.

What do they think this is, Coffee Talk?
posted by caddis at 8:44 AM on March 27, 2006

dear AskMeFi,

my girlfiriend lost two of her fake nails in my ass while she was fisting me; I am now bleeding profusely. also, the house is on fire. should I contact strangers via the Internets or should I call an ambulance and the fire dept (ie, professional help)?
posted by matteo at 8:46 AM on March 27, 2006

matteo, if only we had anonymous responses in ask.mefi my uh... friend.. could let you know how he fixed that exact situation. As it is, I can only recommend a professional and keeping a fire extinguisher on hand next time.
posted by mikeh at 8:53 AM on March 27, 2006

There's one thing that a therapist can provide that a responses to an emotional AskMe question cannot - a dialog. Until we get a feature where anony-mouses can respond to comments in-thread, we'll never be able to get enough information to make a really good, solid response to the poster if it's an iffy or especially troublesome situation. While we live in the land of too little information, suggesting therapy is a safe option.

Also sometimes people just need to be told that.
posted by soma lkzx at 8:54 AM on March 27, 2006

my girlfiriend lost two of her fake nails in my ass while she was fisting me;

Luckily, you were wearing your Lee Press-On Ass.
posted by jonmc at 8:55 AM on March 27, 2006

I find it pretty silly how quickly and casually people throw out the therapist option. I noticed this a long time ago and have done a small bit of research into it. So far it seems really to be a cultural thing. It's not based on any sort of evidence, there is no clear, obvious "therapy success rate" as there is with other medical professionals. It just seems that people would rather talk to with an essentially anonymous person about their problems rather than a friend and there's the whole 'faith in science' thing.
posted by nixerman at 8:56 AM on March 27, 2006

AskMeFi questioners are too often glibly told to, "talk to a therapist," when asking about emotional issues. Discuss.

This is not true. Actually they're told to see a therapist more seriously, and less frequently, than is probably warranted. I'd much rather have three people saying "this is exactly what therapy is for" than try to whip some diagnosis out of their ass on the spot with too little information.
posted by jessamyn at 8:57 AM on March 27, 2006

See also: Rejected AskMe Questions (self-link).

Damn you Matteo! Another coffee-encrusted keyboard down the tube.
posted by KevinSkomsvold at 8:59 AM on March 27, 2006

Pehaps this is something you should discuss with your therapist.
posted by JanetLand at 9:01 AM on March 27, 2006

matteo, next time have your girlfriend wear an armored glove; that way she won't have the annoyance of losing her nails. And I'm sure you've thought of this by now, but you can use the blood to put out the fire!
posted by languagehat at 9:11 AM on March 27, 2006

Answers come from knowledge, not certification.

Thanks for the glib platitude. Now pretend you're smart, and assume that other people are, too. When people say, "Go to a therapist," what they're actually saying is usually, "The nature of your problem precludes strangers from offering much insight or helpful advice based on the 15 sentences you've posted on the internet. You need personal, real-world advice, preferably from someone who can bring knowledge and experience to bear on your question. The internet is not a proper forum for your question."

Of course, that's quite obvious and it should go without saying — and it does, between people who give each other the benefit of assuming mutual intelligence. Unfortunately, sometimes a chucklehead comes along and forces us to spell it with crayon.
posted by cribcage at 9:15 AM on March 27, 2006

What Miko said, tens times over. Many posters think their problems aren't big enough to see a therapist, or else that they're too big to be helped by a therapist, and it's good to let people know they won't be somehow abusing the therapy system by entering it just as they are.

But I think it's also sometimes the most responsible advice to give to potentially vulnerable, confused people who are about to get a lot of conflicting advice from strangers of unknown character. In general, I think it's better to work with one compassionate person who can help guide you through a problem (whether that person's a friend, family member, or professional) than to throw your lot in with a bunch of people with strong opinions but no personal experience with you or your life. And since we often have little idea which friends or family members in a poster's life are trustworthy and compassionate, we tell them to talk to professionals.

AskMe can be great as a back-up resource, and I suspect that many people do use it that way, but .... I don't know. I guess I hate to see people's deepest problems turned into a bickering match among strangers without giving the poster the idea that that's not a necessary component of getting their life in a better place.
posted by occhiblu at 9:21 AM on March 27, 2006

have your girlfriend wear an armored glove

what if she loses a bolt, then? I should have asked a professional!

than try to whip some diagnosis out of their ass on the spot

I won't be able to whip anything out of my ass, much less a diagnosis, for at least three weeks, the nice 911 lady just told me.

seriously now, jessamyn has a point -- sometimes, especially in health/medical threads, it's much better to suggest, delicately, that one seeks help from a professional instead of trying to diagnose something over the Internet
posted by matteo at 9:24 AM on March 27, 2006

Also, I find the anti-therapy thing here extremely odd. Therapy is basically talking about your problems with an objective third party and trying to figure out ways to solve them. Which.... is exactly what AskMe is, but with more people. If you object to therapy, why on earth are you responding to or asking questions here?
posted by occhiblu at 9:25 AM on March 27, 2006

AskMeFi questioners are too often glibly told to, "talk to a therapist," when asking about emotional issues. Discuss.

Please be more specific. Why do you feel this is a problem? As I recall, without looking it up, I suggested counseling to you at one point in AskMe, and if memory serves, you thanked me for the suggestion and said you were going to look into it.
posted by Gator at 9:28 AM on March 27, 2006

dear AskMeFi,

my girlfiriend lost two of her fake nails in my ass while she was fisting me; I am now bleeding profusely. also, the house is on fire. should I contact strangers via the Internets or should I call an ambulance and the fire dept (ie, professional help)?
posted by matteo at 8:46 AM PST on March 27 [!]


Damn you Matteo! Another coffee-encrusted keyboard down the tube.
posted by KevinSkomsvold at 8:59 AM PST on March 27 [!]


That is some quick-drying coffee.
posted by cortex at 9:28 AM on March 27, 2006

No one would object if a poster recommended an orthopedic specialist for someone whose foot was killing them; why should we treat emotional problems any differently?
posted by maxreax at 9:29 AM on March 27, 2006

Isn't it true that in at least some cases, a poster may be assumed to be Asking Mefi specifically BECAUSE he or she wants to AVOID going to a therapist?

I mean, if weirdos on teh intraweb can help for free, why should I pay some talky doctor who wants to know if I really loved my mother when the issue I'm wrestling with is my guilt over setting matteo's house on fire?

I don't know what my point is, I just wanted in on the meme.
posted by BitterOldPunk at 9:31 AM on March 27, 2006

We don't need therapists anymore. Ask Metafilter is here to psychoanalyze you for $5/account. Discuss.
posted by contessa at 9:32 AM on March 27, 2006

the issue I'm wrestling with is my guilt over setting matteo's house on fire?

Stop wiz ze avoidance, mr. BeeterPunk. The real issue is your press-on-nails-in-the-ass envy.
posted by jonmc at 9:33 AM on March 27, 2006

press-on-nails-in-ze-ass, ja?
posted by cortex at 9:35 AM on March 27, 2006

Isn't it true that in at least some cases, a poster may be assumed to be Asking Mefi specifically BECAUSE he or she wants to AVOID going to a therapist?

Yeah, but getting told by 20 people "See a therapist!" would be a good way to gauge whether avoiding one is a good idea or not.

I mean, if someone posted "I think I've broken my leg and punctured my lung, but I have no insurance and there's a homeopathic website saying that calendula is good for healing. Can I just eat the marigolds in the garden and get some bed rest?" I would hope people would violently disagree and tell him to get to a doctor. If someone wrote "I have a big bruise, do I need to see a doctor?" then he'd probably get more varied responses, and most likely at least one "If it's bothering you, maybe it's worth talking to your doctor about it."

I think the same is true of the emotional problems here. It's not really an automatic "Talk to a therapist" response; it seems to be a thoughtful recommendation after evaluation of the problems presented.
posted by occhiblu at 9:38 AM on March 27, 2006

Not only is it unwise to seek serious mental help on chat forums, even online therapists are second rate. I once tried online counseling through www.pleasingtherapist.com, but the doctor was very unhelpful, and he kept telling me to undress. It's like 'dude, how does this relate to my depression at work?'
posted by dgaicun at 9:38 AM on March 27, 2006

Also, I find the anti-therapy thing here extremely odd.

Ask.Metafilter is now run by the Church of Scientology, a vested interest in the utter destruction of those troublesome enthetas, the APA.
posted by carsonb at 9:39 AM on March 27, 2006

pollystark, in the thread that apparently sparked this MeTa, both of the people who suggested seeing a therapist also made other useful suggestions and supportive comments in addition to suggesting therapy -- which in that particular case it is painfully obvious that the anonymous poster needs.

Also, what everyone else in this thread said. You're wrong.
posted by ook at 9:56 AM on March 27, 2006

nixerman writes "It's not based on any sort of evidence, there is no clear, obvious 'therapy success rate' as there is with other medical professionals."

nixerman, you're incorrect. Firstly because therapy is not a medical discipline; secondly because the efficacy of therapy is well and extensively documented. Approx. 80% of people suffering from mental disorders who seek help through therapy are helped by it. More and more evidence is suggesting that neither diagnosis nor severity of presenting problem is an indication that therapy will not work. If you're confused about this you might read Bruce Wampold's The Great Psychotherapy Debate, which is a meta-analysis of the studies which demonstrate efficacy and effectivness. You can look inside at Amazon, but not search inside, or I'd provide a link to the extensive bibliography.
posted by OmieWise at 10:06 AM on March 27, 2006

occiblu,

I don't think it makes any sense to compare doctors and broken legs to emotional issues and therapists. I won't go into it now, since this thread doesn't have to be a referendum on the effectiveness of therapy, but let's just say people wouldn't go to the doctor if doctors didn't actually heal their wounds and cure them of their sicknesses. It's the old physicist/engineer cliche but it's a cliche for a reason.

The problem with the 'therapy' response is that it's used as a catch-all and it's echoed repeatedly. The green would improve if people went beyond the standard response to, perhaps, share their own experiences with therapy or explained how therapy might actually, you know, solve the problem. We could also do without the endless repeats of the 'get therapy' line. In the end, everybody would be helped if people put more thought into their responses.
posted by nixerman at 10:11 AM on March 27, 2006

But... we do. I have. I've read over and over and over again here how therapists have helped others, in what ways, in very specific terms. I had never heard of Cognitive Behavioral Therapy before AskMe, now I feel like I have a pretty firm grasp on its strengths and processes. OmieWise consistently contrasts different therapy styles, and what the benefits of each are. Many many many many many many people have said "I had a similar problem, I went to X-kind of therapist and talked about Y and got a prescription for Z, and now I feel 300% better."

I just have no idea what you're talking about.
posted by occhiblu at 10:19 AM on March 27, 2006

(already regretting my angry closing shot above. Sorry.)

We could also do without the endless repeats of the 'get therapy' line.

I don't agree. For the casual browser who's just skimming through the questions for fun, "get therapy" is a boring repeat. But the person who asked the question isn't skimming through for fun; s/he needs the answer. And often "get therapy" is clearly the right answer.

I'm not a therapy junkie, I don't believe it's a panacea, and I don't think it's for everyone. But a lot of these anonymous AskMe's obviously need more help than a bunch of bored thread-skimmers they met on the internet are going to be able to provide.
posted by ook at 10:21 AM on March 27, 2006

occhiblu, well then we disagree. To me, it seems most therapy responses on the green are in fact the glib, thoughtless 'get a therapist' responses that pollystark is complaining about. This isn't to say that more thoughtful responses are absent--they're not--it's just that they're the exception rather than the rule.
posted by nixerman at 10:23 AM on March 27, 2006

Heh. But that's true of answers on AskMe in general. Why pick on the therapy responses?
posted by occhiblu at 10:23 AM on March 27, 2006

And the thing is, the AskMe that inspired this Meta was written by someone who seems to be having major problems. "Get a therapist" is not, in that case, glib -- it's an extremely responsible suggestion. If someone's having a major problem, telling him to get professional help for it (in whatever arena it may be) is not "glib."

"Get over it, you're being a whiny idiot, it's not that bad" would be glib.
posted by occhiblu at 10:27 AM on March 27, 2006

Y'know, AskMeFi is often the textual equivalent of the "lovelines" radio show that Dr. Drew runs on syndicated talk radio. And the interesting thing is that for the more emotionally charged/medically important issues, even Drew, who is a damned doctor usually tells the caller to seek professional help. Why? Because you can't get all the background you need in a two minute phone call (or a post to AskMe) and it's simply the most responsible thing he can do (or that we can do) in the original poster's best interest.

Just because we don't always like the answers doesn't mean they're necessarily wrong.
posted by TeamBilly at 10:39 AM on March 27, 2006

How about for emotional or relationship issues we just answer "GYOBFW"? Instead of "feigning" concern by "politely" inviting someone to "consult a professional" (a fancy way of saying "fuck off" if you ask me).

This is seriously one of the stupidest, most whiny things I've ever read here.
posted by StrasbourgSecaucus at 10:40 AM on March 27, 2006

eh. wait a little while. I'm sure someone will come up with something worse. they always do.
posted by crunchland at 10:49 AM on March 27, 2006

Most "see a therapist" responses are in threads that I see the people really do need a therapist because they exhibit symptoms of a treatable disorder through therapy. I rarely see break up threads suggest "see a therapist", or anything that deal with the traumas of life. If someone, say, believes someone in their room is watching them -- it might be a good thing a rational third party can tell them they need help. An impartial observer is somtimes what is exactly needed.
posted by geoff. at 10:50 AM on March 27, 2006

By Xenu we should refer them to get E-meter'd instead.
posted by cellphone at 11:01 AM on March 27, 2006

What Miko said. Because she's very, very smart. And right.
posted by Ethereal Bligh at 11:37 AM on March 27, 2006

Stop wiz ze avoidance, mr. BeeterPunk. The real issue is your press-on-nails-in-the-ass envy.

See, that's the problem with therapy. I'm fine with the fisting, it's the arson thing that has me sleepless. You people need professional help. And work on your accent, wouldja?

Is that lube fireproof?
posted by BitterOldPunk at 11:49 AM on March 27, 2006

i thought you could summarize bruce wampold by saying that:
- specific therapies are not important
- what is important is a relationship in which you can work through your problems.
that, and omiewise's assertion that it's not a medical discipline seems to support nixerman's assertion that therapy is a purely cultural preference for sharing your problem with an anonymous partner, and that talking things over with a good friend would be an equally effective alternative.

in other words: it's hard to see what the difference between a therapist and a good friend is, if everyone agrees that the benefits are neither medical nor related to the specific therapy chosen.

and if that's the case, it becomes harder to understand how a dialogue with people via the 'net is inferior to therapy, if that is what the questioner chooses. particularly if matt added the ability for anonymous to reply.
posted by andrew cooke at 12:00 PM on March 27, 2006

(in other words, i think omiewise only defended that therapy works; they did not demonstrate that it is superior to talking to a friend (which could work equally well) or, indeed, to friends via, for example, a web site. and i'm curious if there is indeed any convincing evidence against this).
posted by andrew cooke at 12:03 PM on March 27, 2006

And work on your accent, wouldja?

Mein gott im himmel, such avoidance. Vat is the origin of zese issues. Some lecherous manicurist? Ze bejeweled nails, zey are hurting you ztill, ja?
posted by jonmc at 12:06 PM on March 27, 2006

nixerman wrote...
I don't think it makes any sense to compare doctors and broken legs to emotional issues and therapists. I won't go into it now, since this thread doesn't have to be a referendum on the effectiveness of therapy...

First of all, thanks for showing up. This thread was really dull without pollystark around to actually tell us what the hell she was talking about. In fact, I'm still not sure we all haven't been trolled.

Second of all, this thread largely is a referendum on the effectiveness of therapy. Reading through, you can pretty easily spot who thinks that the therapy is a credible alternative, and those who do not.

Although not a trained psychologist myself (I'm an engineer), I have had several occasions to poke pretty deeply into what happens over in the School of Psychology. Some of it is pretty fluffy, no doubt. On the other hand, they all seem to get a hard grounding in statistical theory and proper experimentation techniques. When the psych community as a whole gets together and actually agrees on something, I tend to listen.

Psychology is very squishy from an engineer's point of view. Almost all of the 'data' they deal with is highly subjective, and occasionally seemingly identical studies yield contradictory results. On the other hand, areas like Family Systems Theory provide such incredibly reproducible results that it's hard to write off the whole thing.
posted by tkolar at 12:17 PM on March 27, 2006

(in other words, i think omiewise only defended that therapy works; they did not demonstrate that it is superior to talking to a friend (which could work equally well) or, indeed, to friends via, for example, a web site. and i'm curious if there is indeed any convincing evidence against this).

I'd say one of the reasons therapists exist is that your friends are not always keenly perceptive, professionally attentive, neutral to the issue, or knowledgeable about the spectrum of human social and mental experiences.

Also:

it's hard to see what the difference between a therapist and a good friend is, if everyone agrees that the benefits are neither medical nor related to the specific therapy chosen.

I don't believe everyone agrees to both of those assertions; certainly not in all cases.
posted by cortex at 12:20 PM on March 27, 2006

Yeah, this annoys me. It can be really really hard to find a therapist, and a bad therapist can do more harm then good. Also, I'm sure that anyone who posts to AskMe has already considered the therapist option.
posted by Afroblanco at 12:20 PM on March 27, 2006

A lot of is developing an ongoing relationship with a supportive, compassionate listener who does not try to intervene in, or further complicate, the existing problems.

What OmieWise has often said is that therapy is most effective due to the rapport that develops between the therapist and the patient. You can't get that on a website, or at least certainly not in the AskMe format where it's basically hit-and-run (I mean, we're not going to keep counseling someone over the course of months or years here).

And in my experience, it's hard to find friends who will truly listen to you without judgment or without trying to "fix things" for you, and it's hard to be able to open yourself up to friends in the same way you can to a therapist (because you don't have to take your therapist's feelings into account, whereas you generally do with your friends). And there's a reason that counsellors and crisis-line phone staffers and therapists go through training -- it's hard work and often counter-intuitive to let people talk through all their feelings about something without diving in to make it better.

Which is not to say that everyone always needs a therapist, just that there are specific advantages to working with one.

To be more specific: After my mother died, I was carrying around all this horrendous pain and guilt and sadness. I had friends that I would talk to about it, and spend time with, but it was only with my therapist that I felt I could really say the things that were bothering me most -- those sticky parts like how mad I was at my mother, how much I worried that I had somehow killed her myself by "breaking her spirit" or something, just how deeply deeply deeply hurt I was. That's not the kind of thing you can necessarily throw on a friend and expect him to hold it without judging you. (I mean, now that I'm not in the throws of thinking, "Oh my god, I'm a monster," I can expect that, but when those thoughts make you dissolve in terror and fear, they're harder to share with people whose opinions matter to you.)

Friends also, to some extent, don't push you to find solutions in quite the same way therapists will. They've found, for instance, that patients paying out of pocket tend to progress faster than those whose insurance covers their therapy. The act of paying someone makes your problems, and progress, official in a way that can be helpful.
posted by occhiblu at 12:21 PM on March 27, 2006

Saying "see a therapist" is easy to see as an American-middle-class-centric thing to say, though.

After all, it's America that has the culture of everyone seeing therapists, where in other countries people often prefer to take responsibility for their own problems.

The middle class part comes in when you consider the fact that therapists are really expensive. Assuming that everyone can afford one is dubious at best.
posted by reklaw at 12:23 PM on March 27, 2006

Saying "see a therapist" is easy to see as an American-middle-class-centric thing to say, though.

After all, it's America that has the culture of everyone seeing therapists, where in other countries people often prefer to take responsibility for their own problems.

Oh, horsehit. Any therapist worth their salt makes you take responsibility for your behaviors, if possible and treats them. To say that "see a therapist" is simply a knee-jerk American reaction is to miss the point completely and it's intellectually dishonest. They do have counselors in Europe and Canada, for example, and I'm sure they aren't starving. Wonder why?
posted by TeamBilly at 12:28 PM on March 27, 2006

Oh, and I don't know of a single therapist who doesn't work on a sliding scale to meet with patient's budgets. Most do.
posted by TeamBilly at 12:31 PM on March 27, 2006

I agree with BitterOldPunk that a lot of emotional/mental health-related AskMes are posted by people who recognize that they have an issue, but are perhaps underestimating it or are reluctant to physically address it.
In such situations, a "See a therapist" response is the best possible answer.
Personally, I think AskMe is better used when asked for ways to find good therapudic/psychiatric help than in solving the Asker's actual problems.
posted by Alvy Ampersand at 12:36 PM on March 27, 2006

I'd say one of the reasons therapists exist is that your friends are not always keenly perceptive, professionally attentive, neutral to the issue, or knowledgeable about the spectrum of human social and mental experiences.

(i'm not sure that's true of all therapists - in my experience picking the right therapist is as important as picking the right friend, but...) my broader point was that if the above is true then you'd expect the kind of therapy to be important, since diffrent therapies will have quite different emphases. yet the reference omiewise gave seems to argue that this is not the case.

on the other hand you would expect a forum like this to have wider experience of "the spectrum of human social and mental experiences".

i honestly don't see a clear argument that a good therapist is better than a good friend.
posted by andrew cooke at 12:37 PM on March 27, 2006

Also, I'm sure that anyone who posts to AskMe has already considered the therapist option.

This is not true. Many people who post their weird symptoms in AskMe don't even know that what they're doing is a textbook case of {whatever people are recommending therapy for}.

therapists are really expensive

This gets into the health insurance sticky wicket again, but for people with health insurance in the US usually some amount of therapist face-time is free with the price of admission. Since the majority of MeFi skews towards middle class Americans this is an unsurprising and not particularly problematic outcome. I'm actually suprised that more people don't say "Consult a spiritual advsor" for some of the soul-searching non-medical questions. You see it all the time in Dear Abby, rarely here.

For people who are dealing with potentially treatable and often undiagnosed-seeming serious mental issues (and we've seen them, and they're not the "should I give in to my boyfriend's desire for a three-way?" questions either) having a peanut gallery of people saying "therapy could help this" does not seem like a bad thing at all. The difference between giving someone with OCD a bunch of different coping skills and strategies, versus getting them therapy and/or medication that actually solves the problem is a sort of big difference. If you don't even know you might have OCD, suggessting therapy seems like a best answer scenario.
posted by jessamyn at 12:38 PM on March 27, 2006

(ooops, missed "than any one therapist" after wider...)
posted by andrew cooke at 12:38 PM on March 27, 2006

(in other words, i think omiewise only defended that therapy works; they did not demonstrate that it is superior to talking to a friend (which could work equally well) or, indeed, to friends via, for example, a web site. and i'm curious if there is indeed any convincing evidence against this).


It's not evidence as such, but: a friend is not as impartial as one hopes a professional would be. A friend may well hold back on saying something to you out of a desire to not hurt your feelings. A friend is probably expected to know something about your situation so you might not think to explain or describe everything to them even though their understanding of circumstances could be wrong.

As for a website...there are nuances in tone of voice, and other nontextual cues that could be critical in assessing someone's mood. The way people write or type is frequently different from the way they speak which could be more reveaing about their mental state. Nevermind that some questions are posted anonymously and the original poster doesn't have a chance to respond anonymously...
posted by juv3nal at 12:41 PM on March 27, 2006

versus getting them therapy and/or medication that actually solves the problem

i understand how - and have been amazed by - medication solving the problem, but can you explain how therapy is something other than learning to cope? (this is particularly true of cognitive therapy, in my experience, which seems to be most often advocated here).

the point of this thread was not medication, but therapy. omiewise has said that therapy is not a medical practice and i'm kind of surprised that you mix the two. for example, at least here in chile, psychiatrists/counsellors do not prescribe medication; that is the job of a psychologist.

[on preview] on the other hand a good friend is likely to know you better than an anonymous practitioner, no matter how expensive they are; i have already conceded that it being unable to reply here is a problem. and again, the broader point is that if this "professionalism" is important, than why is there no difference between different therapists. which is it only the "sitting down and talking/thinking" that unites them all that seems to be important? practitioners of different therapies will have different views about how actively to intervene (indeed, even practitioners of the same therapy).

i'll add that people seem to be comparing a bad friend against a good therapist.

and finally i'll close by saying i think people underestimate the support that this place can give. maybe matt should charge more for membership. as someone said up-thread, people think things are more important when they pay more...
posted by andrew cooke at 12:51 PM on March 27, 2006

After an hour, one of the very few AskMe questions posted by anonymous that couldn't be legitimately answered by "see a therapist" has yet to receive a response.
posted by Prospero at 12:54 PM on March 27, 2006

Well, Wampold's book is dense and rich, so there's a lot to it. (I found it in my trunk during lunch, which makes referring to it easier.) I have elsewhere said that one of the things we can take from the book is that the specific effects (eg. intervention X related to disorder D results in improvement I) are not really supported by the psychotherapy research, but that general effects are very much supported, as is the efficacy of psychotherapy. This means that it doesn't really matter which type of therapy you choose, they all work about equally well, provided they are indeed methods of psychotherapy. nixerman's contention was two-fold, that therapy's efficacy is unsupported by evidence and that it is therefore a result of cultural preference to suggest therapy as a cure.

Both nixerman and andrew cooke may be correct, and, indeed, certainly are, when they talk about therapy as a culturally relative activity. But it has also been clearly demonstrated to be helpful and efficacious. Eysenck's studies from 1952, 1961, and 1966 claimed to show that therapy did not work and that there was a spontaneous remission rate for mental disorders approaching two thirds, but those studies were widely shown to rest on selective use of the research and questionable assignment of unequivalent controls. On the other hand, Smith and Glass in 1977 and Smith et al. in 1980 used meta-analysis of studies which were either randomized post-test only control group design (which compare differences between clients treated and clients requesting treatment but not receiving it until after the experiment was over) or randomized pretest-posttest control group design. They found:

"The 375 studies produced 833 effect size measures (more than 2 per study), and yielded an average effect size of .68.[...]This effect would (a) be classified as between a medium and large effect in the social sciences, (b) mean that the average client receiving therapy would be better off than 75% of untreated clients [...]translate into a success rate of 34% for the control group compared with a success rate of 66% for the treatment group."(Wampold, 66)[My apologies for misquoting more than once the overall benefits of therapy, which I confuse too often with the percentage doing better than the untreated sample. It must be a Freudian slip on my part.]

In 1994 Lambert and Bergin conducted another meta-analysis that found "the average effect associated with psychological treatment approaches one standard deviation unit," in other words, an effect size approaching 1.00. Other work from the 90s supports this data.

So, the studies demonstrate that therapy works, and the meta-anlyses indicate that it works for most people and better than doing nothing. We cannot answer the question of whether seeking advice on the internet works in this way, except in the terms of cultural preference unsupported by research which nixerman proposes. In other words, while we can say for sure that therapy works better than no treatment for most people, we cannot make that claim for AskMe, meaning that suggesting therapy is a legitmate and responsible thing to do. On the other hand, we might be persuaded that most people suffering from mental disorders or anguish do seek advice from friends and elsewhere, which would mean that the control subjects in the studies alluded to were seeking such advice. If this is true, and we don't know if it is or is not, then this further suggests that suggesting therapy is a good idea, since it would imply (an implication that seems entirely reasonable to me) that people in want of treatment are not inert in their lives while they are not being treated.

Finally, as helpful as AskMe might be, there are some real limitations on the activation of what could be called the common factors (the general therapuetic effects--which can be abbreviated to Relationship Hope & Plan) within the context of the answers provided. The most glaring one is that there is no mechanism for anon posters to engage in the conversation about their own problems. But, in addition, there is a recognized limit to internet alturism, coupled with no mandated terms of confidentiality, that probably effects the length and detail of many of the conversations, even when people have not posted anonymously. There are also frequently conflicting responses, which must be weighed and decided upon. The bottom line is that AskMe may be (and is!) great, but I don't think that it can claim to be therapuetic in the sense in which the word is used in the accepted research.

In order to clarify, while I clearly think that therapy works and is very useful in many situations, I'm not actually that big a proponent of psychotherapy as panacea. I think that it's best as a desired, targeted treatment meant to address specific limitations and problems. I view it as much closer to a visit to the dentist, sometimes for a cleaning, sometimes for a root canal, than to a quais-religious exploration of life and values. I do think that all of the research suggests that if one is suffering from a mental disorder, psychotherapy is a great, first-line treatment option.
posted by OmieWise at 12:55 PM on March 27, 2006

Also, I'm sure that anyone who posts to AskMe has already considered the therapist option.

(Don't mean to deadhorse this). Maybe some have but only as a last resort. Human nature is to seek the path of least resistance and find a quick fix to difficult life problems. I've done it a million times. AskMe, I believe, handles the middle ground very well in terms of offering a pacifier or buying time for someone in pain but in the end, who here, typing on a keyboard miles and miles away, is really going to have the resources to help someone who needs it?

A high percentage of the posts that I've seen recommending therapy are usually coupled with someone's personal anecdote in relation to the stated issue. I don't think it's as flippant and crass as the original poster would like us to believe.
posted by KevinSkomsvold at 12:57 PM on March 27, 2006

Well, therapy *is* learning to cope in many ways. You're talking to someone who's trained in teaching people different ways in which to cope.

It's like whether you should ask your friend who's a native Portuguese speaker to help you learn the language or go to a structured class. Some people can hang around the language and pick it up, other people need more defined grammar rules and pronunciation practice before they're comfortable. And some people in that class might learn better from a teacher with a real old-school grammar approach, others might learn better from role play, some might ask lots and lots and lots of questions, others might learn better by hanging back till they get more of a feel for it.

I think the main advantage of therapists is that they've been specifically trained to deal with lots of different people, and to help all sorts of learners learn.
posted by occhiblu at 1:04 PM on March 27, 2006

No.
posted by ikkyu2 at 1:04 PM on March 27, 2006

(To close my analogy:) So your Portuguese friend, fluent as he is in Portuguese, may not be the best teacher for you. I'm sure everyone has lots of emotionally competant friends, but not all of them can really help you decode your problems.
posted by occhiblu at 1:07 PM on March 27, 2006

On preview (that last comment took a while to compose): I hope it's clear that what I'm saying, anyway, is that we just don't know if "talking to a friend" is a good option. What we know is that ~80% of people who want treatment and see a therapist do better than people who want treatment but don't. That's what the data tells us. I would point out that therapy and the therapuetic process is pretty complex, much more so than talking to a friend. There's a lot going on for everyone involved. I just don't think that one can assume that they're equivalent when there is such convincing research saying that therapy works.

In addition, and not at all incidentally, the suggestion that talking to a friend is equivalent to therapy seems to also imply that therapy as an activity isn't grounded in anything specific, like training, and by extension, that it's unscientific. The later is certainly open to debate, but the research into therapy's efficacy is scientific and has been repeated across numerous studies (in the hundreds if not thousands). Regardless of the mechanism for change, we know therapy helps people.
posted by OmieWise at 1:09 PM on March 27, 2006

more like "talk to the hand" am i rite? am i rite?
posted by keswick at 1:21 PM on March 27, 2006

I'm actually suprised that more people don't say "Consult a spiritual advsor" for some of the soul-searching non-medical questions.

On MetaFilter? Are you mad? Even if I believed in spiritual advisors, I'd have to put on my asbestos underwear before daring to suggest something like that. Hey, don't knock asbestos underwear till you've tried it!

Also, WTF, pollystark? This is an interesting discussion, but people who start threads like this, especially with that annoying "Discuss," generally stick around to deal with the consequences.
posted by languagehat at 1:39 PM on March 27, 2006

you'd expect the kind of therapy to be important, since diffrent therapies will have quite different emphases. yet the reference omiewise gave seems to argue that this is not the case.

There is so little I can add to the cogent case made by OmieWise and Occhiblu, but I want to call out this point specifically.

I'm out of my depth, but it seems to me that the kind of therapy one chooses is important not because some kinds are shown to be more effective than others -- that seems not to be true, according to OmieWise -- but simply because some approaches suit individual clients' personalities and tastes better than others, probably contributing to their comfort in the therapeutic relationship and their willingness to be a full participant in therapy.

When you, as a therapy seeker, choose an approach, you're presumably choosing something you believe is the best fit with your problem-solving style and your personality. If the therapy is successful, some of the effect may be due to your choice of an approach which is appropriate for you, but some of it may simply be the power of your own belief that it's going to be more effective. I don't have anything to cite, but it does make sense.
posted by Miko at 1:48 PM on March 27, 2006

oooookay, I see we are just about out of time. We can pick this up next week at the same time?
posted by edgeways at 1:59 PM on March 27, 2006

Also, WTF, pollystark? This is an interesting discussion, but people who start threads like this, especially with that annoying "Discuss," generally stick around to deal with the consequences.

The post in the Ask.Me thread that started it all suggests that pollystark threw this question up here as a way to pull the derailment away from that thread, rather than because she necessarily believes opening assertion to be true. I don't think she's obligated to defend a position she hasn't actually asserted.
posted by jacquilynne at 6:49 PM on March 27, 2006

OmieWise: What we know is that ~80% of people who want treatment and see a therapist do better than people who want treatment but don't. That's what the data tells us.

Not to nitpick or anything, but.. What happens to the statistics when the rate of MetaFilter users seeking therapy doubles because everybody on AskMe says "Go see a therapist."?

Considering the other numbers bandied about here, it seems that there is at least a good possibility that the apparent efficacy of therapy would plummet. Or to put it another way, while going to a therapist of your own accord might be a very good thing to do, telling people to see a therapist might be very bad advice (or basically, Miko's point, from a differing perspective).
posted by Chuckles at 7:29 PM on March 27, 2006

Forcing someone to go to a therapist would probably be counterproductive. Suggesting that someone who's (a) already admitted they have a problem and (b) is asking for help with that problem to go see a therapist is a different beast.
posted by occhiblu at 7:49 PM on March 27, 2006

The 'glibness' I've seen occasionally is the "why are you so stupid to be AxMeing this when it's obvious you should go to a therapist if you're depressed." See also alcoholic. Particularly when it's implied that any advice given is moot unless it's the above. (People offering opinions, advice, and personal experiences are not necessarily contradicting the therapist advice, FYI.)
posted by desuetude at 7:56 PM on March 27, 2006

Clarification: I don't mean that every "see a therapist" bit of advice is in this vein.
posted by desuetude at 8:05 PM on March 27, 2006

I think we should all go see a massage therapist.
posted by It's Raining Florence Henderson at 9:03 PM on March 27, 2006

And ask for the 'happy ending'.
posted by dgaicun at 9:23 PM on March 27, 2006

Metafilter: ask for the 'happy ending'.
posted by Chuckles at 9:32 PM on March 27, 2006

IANAMT






I am not a Moist Towelette
posted by It's Raining Florence Henderson at 9:34 PM on March 27, 2006

[Stops wiping rib sauce off fingers with It's Raining Florence Henderson]
posted by Alvy Ampersand at 11:32 PM on March 27, 2006

I should explain my position more fully.

First of all, if someone asks an emotion-based question that indicates they may be in danger of harming themselves or others (either psychologically or physically), clearly the advice should be, "talk to a therapist ASAP." [And possibly, "get a lawyer," as well.]

Also, some questions are about complex issues that are obviously not going to be solved by a primitive dialogue on the internet. However, the majority of questions about emotional issues seem to be posted by people who aren't seeking definitive solutions and just want advice from a wide range of people. They want suggestions like, "give X a try," or, "I had a similar problem and found that Y was helpful." In these instances, the question is usually something that could easily be solved by one of these suggestions, or a heart-to-heart with a friend.

I'm about to start going to counselling to discuss an issue that is too complex to be addressed entirely by discussion with my friends and family, so I am obviously someone who believes in therapy. But what troubles me is the alacrity with which people advise therapy when the "problem" issue is something that can be solved by some reflection, some talking with friends/family and some practical suggestions from strangers on the internet.
posted by pollystark at 4:10 AM on March 28, 2006

And this alacrity/glibness is problematic because going to therapy when it's not required is a financial burden, an emotional burden (having to search one's soul, or having it searched by someone else), reduces people's confidence in their self-sufficiency, and also has the potential to blow a small issue way out of proportion.

[The original thread.]
posted by pollystark at 4:20 AM on March 28, 2006

1) I don't think that the problem in question is a small problem. The thread indicates something needs fixing. Annon. may find a trick to dealing with customer service, but the underling issue s not going to magically go away with a handful of tricks suggested on a message board. I kind of think crippling social anxiety is a legitimate issue to be told to go see a therapist about. We all live with a handful of tricks and coping mechanisms to handle situations, but when you have a system wide problem there is a reason why professionals exist.
2) The flip side of "reduces people's confidence in their self-sufficiency" exists too, enabling people to think they are wholly self-sufficient, when that is plainly not the case.
3) Financial burden is a legitimate concern, but one that may be ameliorated by a)sliding scale b) insurance.
4) Emotional burden, I'd say there is a hell of an emotional burden already existing, the goal is to reduce that burden, which is why you seek assistance.

I can see where you are coming from, but I disagree with your premises
posted by edgeways at 5:44 AM on March 28, 2006

pollystark, what's interesting about your concern vis a vis the linked thread, is that the poster is describing a set of circumstances that, more than many on AskMe, warrant consultation with a professional. Although clearly a supporter of therapy, as I said above, I'm not a blind cheerleader for it in all situations, but the notion that anon's pervasive, persistent and chronic pattern of avoidant behavior is going to be substantially affected by suggestions to just suck it up and make the first call is pretty naive. It seems a lot like what you're advocating is that suggestions to seek professional help are somehow more likely to reult in bad outcomes, when the opposite is much more likely to be the case. Your own (narrow) reading of the question, echoed by several people in the thread, as essentially about making phone calls, is precisely why the opportunity for breadth in explanation and exploration afforded by professional consultation is so helpful. Anon's problems, although framed as a question about customer service calls and lost money, are clearly related to a much broader pattern of social phobia which is actually very treatable, but not if it's viewed as a failure of nerve.
posted by OmieWise at 6:38 AM on March 28, 2006

That is too often the only useful or responsible answer that any of us could give.

Is that what you tell a friend when they talk to you about something that's upsetting them? Maybe you do say it at some point, but man, if that's ALL you're willing to say to them, you are one cold friend.

I agree that AskMe does not survive comparison with therapeutic practicioners. But I think it does survive the comparison of asking friends for advice. Everyone knows it's not professionally licensed or anything like that. There's nothing wrong with saying "see a therapist," but I don't agree with those people who say we shouldn't even have these threads because no one here is qualified enough to give trustworthy advice. Same for medical and legal.
posted by scarabic at 7:14 AM on March 28, 2006

Is that what you tell a friend when they talk to you about something that's upsetting them?

None of my friends are named "Anonymous." I don't invest much time in helping that anonymous stranger who comes up to me in the grocery store ... (er, or in this case, can't under any circumstances, come up to me in the grocery store) ... and asks for my advice.

AskMefi is a great resource, but isn't the expectation of it solving deep emotional issues like that one asking a bit too much of it? In this case, and cases like it, Askme just fails miserably. The majority of us just don't have the kind of investment in any other Mefite to come remotely close to calling them our friend. You really can't make a fair comparison.
posted by crunchland at 7:29 AM on March 28, 2006

The majority of us just don't have the kind of investment in any other Mefite to come remotely close to calling them our friend.

And in those cases where we do, we tend to email/IM/phone each other (as friends do).
posted by Gator at 8:31 AM on March 28, 2006

They want suggestions like, "give X a try," or, "I had a similar problem and found that Y was helpful."

And when the answer is "give therapy a try," or, "I had similar problem and found that therapy was helpful"?

what troubles me is the alacrity with which people advise therapy when the "problem" issue is something that can be solved by some reflection, some talking with friends/family and some practical suggestions from strangers on the internet.

What troubles me is that you seem to be operating with some preconcieved ideas about what therapy is, is for, and is like. I really want to break those down, because they are exactly the notions that prevent people from making simple improvements in their lives.

First of all, we can't assume that Askers have a strong, supportive, and helpful network of friends and family all the time. Even if they do, perhaps they've exhausted those resources already, either by asking for help and finding it hasn't been helpful enough, or perhaps by negatively impacting those relationships because of their unresolved problem. If their problem could be solved by reflection, chances are they wouldn't still be going 'round and 'round in their minds about it, to the point that they've come to an internet discussion board to bring it up. We have to assume that they're here because they believe they may find a useful response here that they wouldn't find elsewhere. Quite often that useful response could be a recommendation of therapy.

And this alacrity/glibness is problematic because going to therapy when it's not required is a financial burden, an emotional burden (having to search one's soul, or having it searched by someone else), reduces people's confidence in their self-sufficiency, and also has the potential to blow a small issue way out of proportion.

It doesn't have to be a huge financial burden always. As many have pointed out, there's help from insurance, there are sliding scales, and there are opportunities for treatment available through non-profits and social service agencies, depending on the problem. If it were a burden, the Asker could certainly ask for help in finding affordable treatment.

An emotional burden? Nah. Trying to white-knuckle it through a persistent difficulty that isn't improving is an emotional burden. Therapy can be an incredible relief, and even pleasant and fun sometimes. It's not necessarily a sob-fest of soul-searching. There are some nice things in our souls, too, and part of therapy may be to help you identify and use your personal strengths to overcome whatever problems are limiting you. Discovering and celebrating those strengths can be a very positive experience -- as can gradually seeing your approach to your problems change, and feeling healthier and happier.

Reduce confidence in self-sufficiency? Well, the idea that we must always be self-sufficient is a limiting one. That's what I referred to earlier when I spoke about people who think pursuing therapy is a sign of weakness. Sometimes we can do a lot better with the help of a trained professional. Think how ridiculous it would be to say "I broke my ankle, but if I went to the doctor to have it set, I wouldn't be self-sufficient enough," or "My furnace stopped working, so I'll just huddle in the smallest room of my house around a space heater because if I called a HVAC person, that would be a sign of weakness and my incapability of handling my furnace problem."

I mean, if I can live an 80% good life by being what I think is 'self-sufficient', that's OK. But if by addressing problems that are limiting my enjoyment of life, my professional performance, my relationships, my ability to offer good work to the world, I can reach 95% or 98%? I'd be silly not to try it. Therapy is to help give you tools to make a better life for yourself. It can move problem-solving along in a much faster and more targeted way.

And blow a small issue way out of proportion? If it were so small, you wouldn't be motivated to spend the money, find the therapist, and show up to sessions. If it's bothering you, if it's holding you back, it's not small.

I used to have some of these ideas about therapy, too, a long time ago. But I happily discovered they were misconceptions. I've been twice in my life to a few months' worth of very helpful therapy. Very helpful. I now see it as no different than seeing a massage therapist when I need help with a painful lower back, a dentist when I need a cleaning, a personal trainer when I need a new workout routine. It's part of caring for yourself. Some people may never, ever need to see a professional for help with their most confusing problems, which is nice for them. But if the help will improve your life, why stigmatize it?
posted by Miko at 8:34 AM on March 28, 2006

scarabic, how many of the AskMe threads you've commented in are you *still* following up on? Conversely, how many of your friends are you in still in touch with?

I would assume the second number is much bigger than the first.

AskMe is not an ongoing months- or years-long counselling center. Most posts don't stay on the front page or in people's minds for more than a couple days (if that). The people here are great, and most of them are extremely compassionate and helpful, but an emotional problem rarely gets solved in the day or two it gets an airing here. In the best cases, a poster might get some great suggestions and try to implement them in his or her life, but there's no ongoing support for dealing with the consequences of that or for the occasional "I know it's hard, you're doing great, keep at it" that your friends can give you.

I've made friends *through* AskMe, but AskMe itself is not my friend.
posted by occhiblu at 8:48 AM on March 28, 2006

Sometimes AskMe buys me drinks, but I think it's just trying to loosen me up.
posted by It's Raining Florence Henderson at 8:54 AM on March 28, 2006

You thought that was AskMe? That was me! No wonder I never get anywhere with you!
posted by OmieWise at 9:12 AM on March 28, 2006

AskMe never deemed me OT-Level VI and cashed my check. Curses AskMe!
posted by KevinSkomsvold at 9:20 AM on March 28, 2006

I don't understand all you people who come to a community site then bitch about disparate responses and contributions. Someone being nasty to a questioner or rude in the blue, okay, I get that. But too many people think highly of doctors and/or therapists? Dios is too rabid in his pro-conservative posting? If you want every message to match your perspective and priorities then start your own blog and don't tell anyone where it is.
posted by phearlez at 10:54 AM on March 28, 2006

One of the reasons that I think that group therapy can be much more productive than one-to-one therapy is that I think that the counseling profession has embraced the "client centered" paradigm excessively. There's a lot of people that need to be confronted, not comforted, about their behavior and in a group setting, the other group members to some degree play that role. I don't mean to create an opposition between client-centered and confrontational therapy—I think both are productive and necessary.

But the reason I mention this is that an AskMe interaction to some degree plays that "no bullshit" role that the asker is unlikely to get from a counselor. I think that's a good thing.

In any case, it seems to me to be highly unlikely this idea that too many people are relying too casually on excessive therapy. Comparing it to a medical situation, the people that behave that way are hypochondriacs. And they exist. But it seems to me that reading AskMe for any length of time strongly suggests that people are, on average, more reluctant to see a doctor than they are to deal with it on their own. I don't see much reason to believe that the same isn't true with emotional/psychological problems. If we tell people to see a therapist, I think the result will be far more people who do so that need to do so than the number of people who do so that don't need it.
posted by Ethereal Bligh at 2:26 PM on March 28, 2006

AskMe is not an ongoing months- or years-long counselling center.

That's a good point, though it doesn't mean AskMe can play no counselling role. AskMe is good at fulcrum points, dead ends, decision points, etc. These are time-limited, true, but they can be very valuable. I have plenty of momentous, very memorable and important - yet limited - conversations with real friends. My friends are always there for me, blah blah, but it's often one single moment of support/challenge/inquiry that makes a helpful change for me.
posted by scarabic at 2:42 PM on March 31, 2006