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How do therapists ACTUALLY help people?
I'm a little uncertain how to phrase this question - it's both very general and very specific, and I'm not sure if it's about the field itself or how the field presents itself. This may be rambly so thanks in advance for your patience. And let me know if this is the wrong forum - I wasn't exactly sure where to ask this.
(Disclaimer: I'm not asking for specific advice, I'm just bringing up an example to illustrate my question. I am no longer in touch with this person so don't be afraid that I'm asking for advice on how to therapy her.)
Many (many) years ago I briefly dated a person who had ... lots of problems. Severe childhood sexual abuse; chaotic alcoholic parents; adult history of chronic substance abuse. She was high achieving (IQ trumps everything) but totally chaotic - emotionally labile, self-objectifying, used her sexual allure to control interpersonal interactions, would react to (her own) emotional vulnerability by detaching into weird fugue states, intolerant of perceived rejection, thrill-seeking ... you get the picture.
Now, as a person with a reasonable education and access to The Internet, I very quickly decided she was Borderline - the diagnostic criteria might as well have had her picture next to them. The etiology is very easy to understand in an obvious pop-psych way: childhood trauma destroyed her ability to emotionally self-regulate so she self-medicated with booze, she PTSD-detached from her emotional centers and now can't connect with other people because closeness is terrifying as it recapitulates the previous unprocessed trauma, etc etc etc. All very obvious, easy to look up, everything makes sense. In my experience this is easy to do for any disorder: the internet abounds with easy-to-access DSM-derived categorizations and diagnostic criteria, and if you have any brains at all it's almost trivial to play connect-the-dots with reductive "you're compulsive because mommy was a narcissist" pop-psych stuff. Not that anyone is completely reducible to pop-psych catchphrases, but to first order stuff like that is very useful. Fine.
Now, for the life of me I can never find anything that gives an inkling of a clue for how therapists actually approach trying to fix a person like this. Diagnoses abound; treatments are scarce. Sure, there'll be stuff like "BPD can be addressed with CBD, Dialectical therapy, blah blah blah" but NO ACTUAL INFORMATION like "well you need to establish transference so that she can re-experience the trauma in the following structured way" or "here's a schematic for approaches: if she resists questions like that indicates which is best addressed by ." Not that mental illness is recipe-based, but it seems to me every therapist should have a long list of analytic prescriptions like this to at least draw from; otherwise, how do they do anything?
My question, I guess, is where is this information? Is that only something you learn in residency? Is there a secret textbook only therapists get that the rest of us aren't allowed to see? Do you guard the answers because it has the risk of making patients treatment-resistant? Is it because you don't want to give the answers away for free? Is it that I can't find it because it doesn't exist because therapists don't actually do anything besides diagnose and then listen attentively until patients get tired of writing checks? Seriously, what's the deal?
And please, no sanctimonious answers like "it doesn't exist because therapy is more nuanced and can't be reduced to reductive recipes and your arrogant assumption that you know how to diagnose complex cases just shows you're an obnoxious unintelligent asshat that I refuse to talk to except of course to explain that I refuse to talk to you." Yes, yes, we're all beautiful and unique snowflakes - but that doesn't mean there can't be real information on the structure of ice crystals that allows you to better understand them. And just for the record, my prior on this lies somewhere between "it only exists in specialized textbooks that no one puts online" and "therapists don't actually know anything, they're just good listeners" (i.e., the Dodo Bird's Verdict) so I will interpret any aggressive non-answer like the above as I-just-got-pegged-defensiveness and it will only cause me to lean into the latter belief. Sorry if this sounds snarky, but this is Reddit and I do get tired of talking to self-righteous morons sometimes
submitted by BayesianPriory