A psychotherapist is in a pretty unfavorable situation. He has a patient/client, who is not OK mentally(otherwise wouldn't need a therapist). It doesn't mean insanity but surely some form of distortion of reality.
The patient-therapist confidentiality prevents the therapist to gain reliable external information for these non-hospitalized patients. He can't just walk to one's family members or boss and ask about his patient. So he is stuck with the information that came from a very unreliable source: a sick person talking about himself.
To make things worse the World is far from being perfect. Other people can be very unfair, unethical or even outright illegal with the patient. While the therapist can figure out that the one telling "I get commands from a dog" is not telling the truth, the one who claims "my boss wants to fire me because envious to my skills" can easily be in distress describing something completely true. In such cases asking around wouldn't help the therapist even if it would be possible.
I'm honestly surprised that the therapists have any progress despite these serious disadvantages. The reason why most therapies are "awkward" is exactly to overcome the disadvantage: as the therapist is running blind, he just accepts the patient, parrots his words, sit at his bed, ask introspective questions, allowing the patient to figure out things on his own. How much easier it would be if the therapist could say "I know for sure that your wife is not cheating on you, so we shall only talk about why do you still fear from that"?! But he cannot as he can never be sure.
The MMOs are virtual worlds, where people encounter with other real life people. I believe that playing MMOs is a perfect place to run therapies as it would allow to overcome the above disadvantage. In short, the therapist can always know the objective truth about one's playing, so never should guess if someone is distorting reality due to his psychological condition, or he is in an awkward situation. With a simple addon someone's playing time can be completely documented: where he was, what he did, how did he perform, what he chatted and so on. The therapist would have an accurate, complete and searchable log about his patients activity: the holy grail of therapists.
For example the patient claims "I did not get promotion because I'm a woman". The therapist is completely oblivious if she is a victim of sexism who needs reassurance and coping strategies, a bad employee who is lucky to still has a job or someone whose personal behavior draws negative reactions. On the other hand if she plays the game and claims "I did not get spot because I'm a woman", looking into the last raids combat log analysis and reading the chatlogs her computer saved (maybe with voice chat recordings) is completely enough to decide if she is a victim, a terrible player or a drama queen.
Also, the game is simple and needs minimal real life skills. Sucking in real life can be because of lack of childhood education and/or low IQ that a therapy cannot fix. On the other hand the game is extremely simple in mechanics and only demands technical skills that any non-handicapped person has.
Failure in the game can happen if one has very little motivation (it's a game after all), but for the patients who play as part of their therapy this isn't the case. They are motivated to get better and agreed with the therapist that they will take their "gaming" seriously. Slacking after such agreement (and paying the significant therapist fee) is in itself a symptom.
If someone is motivated to reach the pre-set gaming goal and not handicapped, the only reason to not reach his goal in proper time is having a psychological condition. Maybe can't organize his time and gets unfocused (doing BGs when the goal was raiding). Maybe he has problem accepting criticism. Maybe he believes that rules don't apply to him. Maybe his obnoxious style alienates everyone. Maybe he can't control his impulses and ninjaes. Maybe he is unable to say no. Maybe he is attached to people pulling him back. Anyway he is at fault and the logs clearly say how.
Gaming has another therapy value: immediate response to changes and no memory. If you were cheating on your wife and it got out, the divorce will go on despite the underlying cause was fixed. The therapy may save your nex relationship, but not this one. People (especially those who have problems) want results now. In the game you can get a fresh start by a server/namechange so your past mistakes can't haunt you. The reactions of people will only depend on your current actions and these reactions tend to be quick.
The quick moving also prevents blaming others. Problematic people always have someone to blame for their problems. Usually not without ground, as the people around us are far from perfect. However in an MMO if he starts blaming someone for his failure, the therapist can always cut it with "OK, you are maybe right, let's gquit or even transfer server, away from this guy".
As a third positive, gaming is completely safe. Other players can't really harm you. This allows one to risk-freely try out different behaviors, while in real life changes could upset people who can turn on the patient (or he wrongfully believes that they will). It works both ways, the patient can't harm his fellow players either, so if he believes in something (like beating people up is a good idea), he can try it out without harming anyone. He just get some /ignores.
The fourth reason to support the "MMO in therapy" is low therapist load. The patient can spend most of the time "alone" in the MMO, at his own schedule, the therapist is needed just few times a month to talk the experiences over. As the logs are in a computer format, it can be done over the internet, so the therapist can be anywhere and oversee the case from the distance if a program is running to upload the data the addon collected.
The patient-therapist confidentiality prevents the therapist to gain reliable external information for these non-hospitalized patients. He can't just walk to one's family members or boss and ask about his patient. So he is stuck with the information that came from a very unreliable source: a sick person talking about himself.
To make things worse the World is far from being perfect. Other people can be very unfair, unethical or even outright illegal with the patient. While the therapist can figure out that the one telling "I get commands from a dog" is not telling the truth, the one who claims "my boss wants to fire me because envious to my skills" can easily be in distress describing something completely true. In such cases asking around wouldn't help the therapist even if it would be possible.
I'm honestly surprised that the therapists have any progress despite these serious disadvantages. The reason why most therapies are "awkward" is exactly to overcome the disadvantage: as the therapist is running blind, he just accepts the patient, parrots his words, sit at his bed, ask introspective questions, allowing the patient to figure out things on his own. How much easier it would be if the therapist could say "I know for sure that your wife is not cheating on you, so we shall only talk about why do you still fear from that"?! But he cannot as he can never be sure.
The MMOs are virtual worlds, where people encounter with other real life people. I believe that playing MMOs is a perfect place to run therapies as it would allow to overcome the above disadvantage. In short, the therapist can always know the objective truth about one's playing, so never should guess if someone is distorting reality due to his psychological condition, or he is in an awkward situation. With a simple addon someone's playing time can be completely documented: where he was, what he did, how did he perform, what he chatted and so on. The therapist would have an accurate, complete and searchable log about his patients activity: the holy grail of therapists.
For example the patient claims "I did not get promotion because I'm a woman". The therapist is completely oblivious if she is a victim of sexism who needs reassurance and coping strategies, a bad employee who is lucky to still has a job or someone whose personal behavior draws negative reactions. On the other hand if she plays the game and claims "I did not get spot because I'm a woman", looking into the last raids combat log analysis and reading the chatlogs her computer saved (maybe with voice chat recordings) is completely enough to decide if she is a victim, a terrible player or a drama queen.
Also, the game is simple and needs minimal real life skills. Sucking in real life can be because of lack of childhood education and/or low IQ that a therapy cannot fix. On the other hand the game is extremely simple in mechanics and only demands technical skills that any non-handicapped person has.
Failure in the game can happen if one has very little motivation (it's a game after all), but for the patients who play as part of their therapy this isn't the case. They are motivated to get better and agreed with the therapist that they will take their "gaming" seriously. Slacking after such agreement (and paying the significant therapist fee) is in itself a symptom.
If someone is motivated to reach the pre-set gaming goal and not handicapped, the only reason to not reach his goal in proper time is having a psychological condition. Maybe can't organize his time and gets unfocused (doing BGs when the goal was raiding). Maybe he has problem accepting criticism. Maybe he believes that rules don't apply to him. Maybe his obnoxious style alienates everyone. Maybe he can't control his impulses and ninjaes. Maybe he is unable to say no. Maybe he is attached to people pulling him back. Anyway he is at fault and the logs clearly say how.
Gaming has another therapy value: immediate response to changes and no memory. If you were cheating on your wife and it got out, the divorce will go on despite the underlying cause was fixed. The therapy may save your nex relationship, but not this one. People (especially those who have problems) want results now. In the game you can get a fresh start by a server/namechange so your past mistakes can't haunt you. The reactions of people will only depend on your current actions and these reactions tend to be quick.
The quick moving also prevents blaming others. Problematic people always have someone to blame for their problems. Usually not without ground, as the people around us are far from perfect. However in an MMO if he starts blaming someone for his failure, the therapist can always cut it with "OK, you are maybe right, let's gquit or even transfer server, away from this guy".
As a third positive, gaming is completely safe. Other players can't really harm you. This allows one to risk-freely try out different behaviors, while in real life changes could upset people who can turn on the patient (or he wrongfully believes that they will). It works both ways, the patient can't harm his fellow players either, so if he believes in something (like beating people up is a good idea), he can try it out without harming anyone. He just get some /ignores.
The fourth reason to support the "MMO in therapy" is low therapist load. The patient can spend most of the time "alone" in the MMO, at his own schedule, the therapist is needed just few times a month to talk the experiences over. As the logs are in a computer format, it can be done over the internet, so the therapist can be anywhere and oversee the case from the distance if a program is running to upload the data the addon collected.
22 comments:
An interesting hypothesis, but I don't believe it would work for serious psychological issue. Maybe self-esteem problem or social innability could be analysed using MMO but real mental sickness are way too complex to be understood that way. It could even be dangerous to put a serious mental patient in an uncontrolled environnement like an online game. What we see as "completely safe" may not be the same to them.
Therapy doesn't work this way. It's not enough to know what is wrong with person, as you can't heal him by just pointing him to the thing where he's obviously wrong. He himself knows that he's wrong, that his wife is not cheating him but he fears of it - otherwise he will be not with therapist, but in court for divorce. Or he knows for sure she is, but he just can't abandon her and can't let her cheat at the same time. Client knows what he wants to do, where he's wrong, but he just can't make himself acting the way he feels needed. Instead he's doing things he doesn't even want to do.
Therapist needs to get the deep thought from inside of him out for him to see that this thought is making him to act the way he himself founds not appropriate.
That's why it doesn't matter much for therapist if the wife of his client is cheating or not. Most of the time in your life you don't know for sure what other people do when you can not see them. You can't also know what do they think, you can just hear what do they talk. And every socially adapted person needs to get used to act in such conditions and act healthy.
Client confidentiality doesn't really work the way you think. Although it can sometimes compel the therapist to keep quiet about the fact that therapy is going on, it doesn't have to. In fact family therapy is quite popular, not only due to the fact that members of families are sometimes "delegated" to therapy for a problem that is systemic in the family rather than personal (only one member of the family shows symptoms of a larger problem). On the other hand talking to all of the client's friends and relations is impossible for practical reasons.
Psychological conditions are not always distortions of reality. In fact, the ones that are, are mostly serious psychoses (paranoid schizophrenia, etc.). As an example: a phobia is a fear of something that the client nevertheless intellectually recognizes as non-threatening; persons suffering from OCD realise that the rituals they feel compelled to perform are completely irrational.
On the other hand: clients lie and emotions do affect cognition. So logs would still be useful.
Also:
"I'm honestly surprised that the therapists have any progress despite these serious disadvantages."
They don't. Studies show that psychotherapy shows equal wellbeing improvement to that of no psychotherapy over the same time. Except maybe for cognitive-behavioural therapy, but that might have been due to bias.
It's an interesting idea to be sure, but there are some problems with it. The obvious one would be that many people would play an MMO for far too long. Also, if they don't play it enough, the therapist won't get enough data. So you are basically asking people with self-admitted psychological problems of all kinds to balance their time perfectly.
A second subtler point is that it might not really matter if a patient is not telling the truth. Usually they aren't talking about completely objective facts with their patients, and if a patient tells his therapist "I work hard, but Bob steals all the credit" the most important thing if you are interested in his psychological issues might not be whether or not he is right, but why he thinks that. His reasons would probably say a lot about his problems. Whether or not he is actually right is something that's hard to decide even given all the data, and something that the patient would maybe have more use of figuring out with the therapist than if the therapist told him "sorry, I looked at the log - you're wrong". I don't know, you might want to take all this with a pinch of salt, I've never used a psychoterapist, but you seem to think that psychological issues means distortion of reality that the patient is not completely aware of or able to 'break'. As other people have said people also have stuff like phobias which they know are silly, yet are unable to deal with, and generally people can know that, say, they lie a lot and hurt the people around them without managing to change without help.
@Casper: "Studies show that psychotherapy shows equal wellbeing improvement to that of no psychotherapy over the same time."
I'd like to see a source on this. I'm not saying I don't believe you, but I was surprised and would like to read more about it.
@Last anonymous: the truth about Bob completely changes the course of therapy. If Bob steals his work, than he most probably needs behavioral assertivity training to be able to stand up to BoB. If BoB doesn't steal, he is either paranoid (cognitive therapy needed) or he diverts responsibility and blames Bob for his failures (years of traditional analysis incoming).
I do believe this is why people who believe in reincarnation are slackers. They're morons because theres no ample proof of their theory.
The Internet, like real life, is a reflection of what we are. We are actors. If the woman is traumatized in the core of her femininity (her father died at young age, her parents were sent to Auschwitz, she was called fat in elementary school, she was raped by her stepfather) this will influence her behavior and her (self-)perception. If she is treated unfairly, the therapist would help her cope with that situation since she is unable to do so on her own. If she is a drama queen, the puzzle doesn't stop there for the therapist. Drama queens are not 100% in the head, you know.
My point here is that you are suggesting to move the puzzle ("the play" if you will) to the virtual world. There is nothing wrong with this! It certainly would have its positive and negative aspects. However, it isn't inherently different from having the puzzle in real life. Or walking around with a camera and voice recorder all day long. Your type of therapy would lack facial expression whilst the person is on voice chat which is a vital part of the analysis of the psychotherapist. It provides important information behind the person's "mask", revealing for example jealousy or joy. (With exceptions. E.g. a person with severe histrionic personality disorder would be able to act in such aspects as well, potentially tricking the psychotherapist.)
"If you were cheating on your wife and it got out, the divorce will go on despite the underlying cause was fixed. The therapy may save your nex relationship, but not this one."
Not necessarily. Unless you mean that the next relationship can occur with the same person. I am not sure about the likeliness on this (research showing percentage), but it is possible. Very dependant on culture, too. When they are together in psychotherapy, the likelihood they want to "get out of it together" is considerable no matter what the issues they're having are. Those could be anything, including the one you mention. Because whatever those issues are they _are_ there. What matters is understanding why they are there, so they can be coped with. As one Anon above me outlined: the "why". You are correct that verifying truth is also important, to establish premises.
"The fourth reason to support the "MMO in therapy" is low therapist load. The patient can spend most of the time "alone" in the MMO, at his own schedule, the therapist is needed just few times a month to talk the experiences over. As the logs are in a computer format, it can be done over the internet, so the therapist can be anywhere and oversee the case from the distance if a program is running to upload the data the addon collected."
The analysis phase takes place in the beginning of the therapy after which testing the theories takes place. This is required less and less, but costs considerable time & money. Once they've analyzed the subject that is what therapists do: "talk the experiences over". After every visit the subject has things on their agenda to cope with. One could refer to them as "homework" or "achievements".
An alternative to your suggestion which is much more realistic and viable is sending the URL of their blog to their psychotherapist. This would give them invaluable information about themselves. Information which is already public, information the psycho therapist could've found by using this service called Google.
Finally, remember there are tons and tons of different types of therapies. The discussion is abstract in relation to these various therapies. What we discuss does not necessarily apply to all of them.
@Gevlon: Sure, but that's exactly the sort of thing you'd reveal when talking to the patient. If the patient says "I think that because he erases my name from the articles that we write" that's a pretty objective fact. If he says "We work together, but my boss gave him a pay raise and not me", they can talk about why he thinks that shows a betrayal from Bob. Most people are/should be honest with their therapist, so I see no reason for them to outright lie about this. If the therapist is sufficiently diligent in asking "well, why do you think that?" at times like that I don't think anyone would say something they know to be a lie, especially not with their therapist.
I'm a psychologist. While your idea holds merit, we have a simpler way of engaging clients in this way. It's called group therapy, and helps us by allowing us to focus on the distortions or communication styles of the people in the group.
For example, if you believe people are always ignoring you, we'll see that in the group and can handle it. Think others slight you? It'll come out. Out to get you? Ditto.
It's not as anonymous as an MMO, but it does have decades of research and practice behind it.
Gevlon, why do you insist on writing things you know very little about?
Firstly, there is a very big difference between a counsellor and a clinical psychologist (or psychotherapist, as you put it). The counsellor listens to a patient and suggests ways to get over their issues. There, they are not actually treating any mental disorder, because there is no distortion of reality caused by mental *problems*, it's all about talking through the patient's perceptions.
Such a person is not sick, he/she simply perceives the world in a certain way. The counsellor simply works to understand why the person perceives the world in that way, and help them realise that there are other ways to view the world.
A clinical psychologist, on the other hand, treats mental illnesses and diseases which can be diagnosed objectively without relying on a patient's conscious observations. You don't diagnose autism or psychosis or depression by listening to what they tell you, you diagnose it by putting the patient through an MRI, by observing their subconscious behaviour, and/or by conducting objective tests with results that can't simply be forged by lying (unless the person happens to be a psychologist and knows the basis of the test as well).
So basically, what you're saying is that it's hard to tell when someone is consciously lying to to someone who isn't fully trained in psychology, nothing more. A psychotherapist will have more tools than just what the patient says, and is concerned with far bigger issues than "nobody likes me".
This conversation is amazing, and a testament to the ignorance that is present in regards to the profession of psychotherapy. I don't know even where to begin.
(Maybe the best place to start is to say that if you, Gevlon, have the same amount of knowledge and experience about other things that you do about psychotherapy, then I lost a bit of confidence in your opinions on other matters. It sounds more like you needed a topic, searched google for some brief information, and threw together a post).
Anyways, more to point -
The premise of using WoW as a medium for therapy does have it's benefits, but the problem is that it further facilitates issues with a client that has problems with understanding reality (and I don't mean psychosis, I mean more normal problems with reality, issues of paranoia, misunderstood intentions, and how a client interprests the actions of others all together).
Someone who can't see their own irrational thinking or distortions in reality ... while WoW, granted will give you some objective data, still doesn't deal with the distortion. Just because you have evidence, doesn't mean the client will believe it.
Example: "Hey man, you said that they didn't invite you back because you're a rogue, but they are saying that it's because of your performance on the damage meters."
Response: "Well, there much have been a glitch ... I wasn't given the best assignment ... the lock wouldn't give me dark intent ... (enter excuse here)."
Most competent therapists instead of immediately challenging these thoughts use a client's thoughts to lead them to their own solutions.
It's simply about what the client wants, tracking the evidence as it leads to them not meeting their goals (whatever they are: silly or serious). Then asking the question: If what you are doing is not getting you to where you want to be, what can we do in addition with that. Fostering a conversation about internal locus of control, and eventually the clients will see that what they are doing is not getting them where they want to be, and will make some changes.
A hard-front approach - i.e. - you are doing this wrong, is the singularly most ineffective therapy strategy in existence. Your client has their parents for that.
And to the poster that said that there is research showing that there is no difference between therapy or no therapy in the change of clients, I would like to see a source, because that statement alone flies in the face of most actual, real research on the efficacy of therapeutic measures ... which use both blind and double-blind control groups, to prove precisely the opposite of what that poster is proposing.
Casper I don't think you understand how confidentiality works. Unless the therapist has the permission of a client then they cannot talk to family members regarding the client.
As a comment to the post as a whole it is an interesting idea. One problem I forsee is that the client's will act in a way different from their baseline because they know they are being watched and information is being taken from them. Therapy is not really about if the therapist belives the client or not. It is to work on peoples reactions to events/perceived events and stop them from being so debilitating on the individual. If someone broke a pencil and was angry the rest of the day because of it, they are having a strong and possibly inappropriate reaction to the situation.
@Anonymous 11:59: I never said they LIE to their therapist. They believe in something wrong. For example he honestly says that "We work together, but my boss gave him a pay raise and not me" while the boss and Bob would say: "Bob did all the creative job, he just did what Bob told him to do. He is a good hand but nothing more".
@Anonymous 12:41: group therapy is limited by the fact that there is no real connection between the members. If X tells that "everybody is hating me", of course the others tell "I don't hate you", as they have no reason to. He won't vomit to their carpet and steal their change to buy vodka like he does with his family. In an MMO you don't just have to talk with people, it's not an online chatroom. You must carry out tasks together. You will experience frustration, failure, success and joy together and react to these.
@Squishalot: calling the patient's delusions "not sick, he/she simply perceives the world in a certain way" is a comforting thing to YOU as you can act like they are fine. The guy who says "I'm above average driver" (when he actually sucks) is maybe not as obviously sick than the guy who accepts commands from a dog, but he is no less delusional. The correct answer is "I can't cure him" and not "he is not sick". Actually, he has a literally life-threatening illness.
@Lorandir: where did I say that the therapist should confront his patient? I said he would have data to talk about. Basis to ask questions.
@Mondka: if the patient can uphold a healthy(er) behavior just because he is watched, isn't it alone worth it?
One problem I see: you are introducing people with psychological issue to a huge source of potential addiction.
If you don't believe there's a real connection between people in group therapy or that they can't have strong feelings about each other (both positive and negative), you either haven't experienced it at the hands of an effective psychologist or haven't done your research on what it is.
I don't think this is a good idea for observing and giving therapy to pedophiles because they can still find children in the game and engage them in improper conversations. Otherwise I think it's a great idea, at least at first, however treatment at some point would have to go past behavior in the game and work on behavior outside of the game, also. I think parallels between life inside the game and out are strong enough that real progress could be made.
I myself have been using the game as self-therapy for money management. I feel that controlling spending habits and saving more money in the game can result in better real-life money habits.
"If someone is motivated to reach the pre-set gaming goal and not handicapped, the only reason to not reach his goal in proper time is having a psychological condition. Maybe can't organize his time and gets unfocused (doing BGs when the goal was raiding). Maybe he has problem accepting criticism. Maybe he believes that rules don't apply to him. Maybe his obnoxious style alienates everyone. Maybe he can't control his impulses and ninjaes. Maybe he is unable to say no. Maybe he is attached to people pulling him back."
If all of those mentioned traits are symptoms of pyschologiccal issues then 10 million WoW players have serious mental problems.
@Yaggle: in WoW kids hide their age as they don't want to look kids. You can't find a single person who call himself below 18
@Last anonymous: most players set the goal "have fun". So they don't have mental conditions, just being little punks.
Interesting. And I think there is some interesting nuggets as to uses for virtual worlds. Perhaps Second Life might be more appropriate than WoW or perhaps not.
1) As to the conventional wisdom that is probably unjust to many in this field but perhaps with more truth than they would like: psychologist are about equally likely to make the patient better, worse or unchanged. Psychiatrists have better success rates due to pharmacology.
2) To what end? In all your examples, I am not sure that even if WoW enabled the professional to see what the problems were with the patient that anything could be done.
Gevlon, don't be an idiot. Phishing is a giant global security concern, capable of even hitting multimillion dollar internet security firms, and you think you can't find some 14 year olds in WoW if you're actually looking?
Pedophiles will put more effort than going on /trade and asking "Who's under 18?" though I'm not certain even that would fail. The popularized cases of internet pedophiles are always about talking to the kids and having discussions with them. There's obviously more investment to the process itself than just gassing some random kid with chloroform and tossing him in the back of your van.
For the post itself, this is absurd. You're acting like MMO's and recording a players behavior is some sort of holy grail for therapy. Yes, seeing how a person behaves provides real value in some cases. Yes, games can be used to create specific situations. No, this can not be applied to every case. I'd be hesitant of even saying "majority" without significant reference from people and research in the industry.
I fully endorse looking to use video games and general game design principles in wider applications, and trying to help people with them. But let's keep it in a reasonable scope. It feels like you're calling a 3D flying sim a tool for curing AIDS because of some possible benefits to researchers visualizing data.
If all you want to stop are drama queens and liars, or even just cases of significantly low self esteem, you hardly need a degree in shrinkology to find them. The skill is in fixing it, not providing evidence for it. Wiretapping someone's WoW won't help in this department.
Also, where did this "people won't lie to their therapist" idea come from? People lie to their parents, to their spouses and business partners, and to their children. Why would someone magically lose their ability to lie to a "know it all shrink who just wants my money", and "I'm just here to make my wife happy anyway"?
The guy who says "I'm above average driver" (when he actually sucks) is maybe not as obviously sick than the guy who accepts commands from a dog, but he is no less delusional.
Would you say this is an above average blog post from an above average blogger who has any idea what he is talking about? The mere fact that you apparently refuse to draw any distinction between levels of delusion is completely ridiculous. Such a black and white definition of delusion means everyone is delusional in some fashion, which renders the meaning of the word moot.
@Last anonymous: most players set the goal "have fun". So they don't have mental conditions, just being little punks.
If someone's goal is merely to "have fun," they certainly would have a mental condition to choose a subscription-based MMO that requires constant internet access and a working PC to have said fun. It is entirely possible to have fun playing with a box or kicking a rock down the street, both of which are much more economical (and healthy besides). People play WoW specifically for more than just fun.
"@Lorandir: where did I say that the therapist should confront his patient? I said he would have data to talk about. Basis to ask questions."
Let me just be clear on this. Your premise involved the understanding that the client was lying to you, so you would introduce the game as a way to get objective data that the client cannot lie about. Correct?
By definition, that is going to be a confrontation, and also, a stronger confrontation than taking a client-centered approach (i.e. - helping them to see that what they are doing isn't working and using that reality to ahve them expose their own lies).
The point I was more trying to make, is that the assumption that because you have "objective data" doesn't on its own impact the client's view of reality.
@Lorandir
The British Journal of Psychiatry (2009) 195: 73-80. doi: 10.1192/bjp.bp.108.054429
Clinical effectiveness of online computerised cognitive–behavioural therapy without support for depression in primary care: randomised trial
For example - the conclusion of this article was that online CBT did not outperform individualized therapy.
Now, a thorough survey of the literature might (probably would) draw a different conclusion. However, for this sample, online therapy did not appear to perform differently from individualized therapy.
And, one of my axioms is that, usually, if people are moderately competent, any result that is hard to measure is usually not important.
Therefore, the difference between individual therapy and online therapy, for some classes of patients is, at best, difficult to measure and therefore likely not important. There did seem to be some differences in treatment adherence. But, from the perspective of a bureaucrat, cost-effectiveness was likely much improved.
(Mind you, this isn't my field, but this does match my observations of some of my friend's experiences with therapy so it passes the believability test. Also, any treatment where the 'get some exercise' and the 'by the time you're going to the therapist you're probably getting better already' effects are comparable to the treatment effect...)
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