> Yes, and when that happens, which it certainly does, it's not science

This is excellent progress. You accept that other areas of medicine can be as bad as psychiatry.

Will you stop dropping into unrelated threads and leaving off-topic rants about the poor quality of psychological research? I doubt it.

Will you be expanding your rants to include other areas of medicine that have poor quality research? I doubt it.

You do make a mistake when you lump in counseling with therapies. Here's one example of you making this mistake:

> You are mistaken. In fact, a careful reading of the literature leads one to exactly that conclusion (i.e. all therapies are equally effective, therefore there is no basis for preferring CBT over IPT, or a psychotherapist over a sympathetic relative). This is a typical crititism of the literature supporting CBT:

They carefully talk about therapies; they are not talking about counseling or about chats with relatives. The research that you cite either ignore such non-specific counseling or says that therapies are clearly superior.

And did you just quote Wikipedia as a source? That's a bit cheeky, especially in a discussion about rigour and quality.

This conversation is probably a bit tedious if we keep talking about where we disagree. Let's look at areas where we agree. Firstly: I agree that a lot of psychological research is not very good. (Where we disagree is that I think most research is as bad. This link is more persuasive: http://wjh.harvard.edu/~jmitchel/writing/failed_science.htm )

> You haven't been talking to psychiatrists lately. To psychiatry, medications are the centerpiece of what they call "biological psychiatry." If medications were to suddenly be withdrawn from the mental health toolkit, modern psychiatry would collapse.

This is a good point. Many psychiatrists rely on medication. Many psychologists would treat everything without medication. Teams that include both often have vigorous discussion about where the balance should be.

A psyhiatrist is not a front line treatment! In England to get access to a psychiatrist you see your GP; and she might refer you to a gateway mental health service; and they might refer you on to see a psychiatrist. But the patient might not go to their GP amd might self refer to a CBT course instead. And the GP could refer you on to a self guided CBT resource, or a community based talking therapy (probably CBT); or prescribe medication and a talking therapy. The gateway team might not refer you to a psychiatrist but could refer you back to primary care with recommendations for therapy and quasi-professional interventions. (EG: someone to help you stay in work or get back to work; some group to increase your social activity, and so on. There's a wide range of non-medical and non-therapy interventions that can be accessed before people need to be medicated.)

Perhaps this is a cultural thing? England has pretty strict guidelines about what treatment looks like. Here's the guidance for depression in adults:

http://www.nice.org.uk/guidance/CG90

> Do not use antidepressants routinely to treat persistent subthreshold depressive symptoms or mild depression because the risk–benefit ratio is poor, but consider them for people with:

> + a past history of moderate or severe depression or

> + initial presentation of subthreshold depressive symptoms that have been present for a long period (typically at least 2 years) or

> + subthreshold depressive symptoms or mild depression that persist(s) after other interventions.

NICE provide guidelines for medical treatment in England. Clinical Commissioning Groups commission local services based on NICE guidelines. While they don't have to follow the guidelines they need a good reason to not do so.

> I have had this precise conversation hundreds of times over the past ten years. Someone defends one or more aspects of psychological research or practice, certain claims are made, then, when the claims are compared to the literature, the claims turn out to be flatly contradicted by the literature.

You need to be a bit careful. You've mistakenly claimed that research shows no difference between "counseling" and "therapy" when, even the papers you cite, it does show clear benefits of therapies over counseling. Some papers show similar amounts of benefit amongst different therapies but that is not the same as saying a therapy is no better than a chat. This is not a benefit to psychologists - it means that counseling is not recommended; counsiling is advised against in the aftermath of local tragedy or disaster.

> In psychology, there are no theories to which research outcomes can be compared. This means studies tend to compare one observation to another, one symptomatic treatment to another.

I want to understand what you mean by this, so I'll ask some questions.

Let's look at CBT. There was a division amoung psychologists for years. One group said you needed to have years of therapy to find and address the cause of current distress - the root trauma. The other group said that the concept of a causal root trauma was irrelevant and you needed to address current thoughts and behaviours.

"Ann" has a phobia of dogs.

The first group would talk to Ann about dogs and try to fid the event that caused Ann to be scared of dogs and so on.

The other group would talk to Ann about her fear and about the physiological reactions that fear causes. They'd talk about Ann's emotions and the thoughts that trigger those emotions, and the evidence for those thoughts, and how strongly she feels those emotions. They'd allow Ann to sit with those thoughts for a while. They'd then ask Ann to think about other evidence, and what her thoughts are, and how strongly she feels the emotions now. Depending on the severity of the phobia Ann will be cured after a couple of hours of work! Severe phobia will see near complete absence of symptoms for two years.

When we research treatment for phobia and we compare these two approaches we find the first therapeutic approach does not work. But we find the second approach strongly works.

We find this benefit across different studies with dofferent controls and different sample sizes. We find it when we do meta analysis. We find it for different phobias; different age groups; different populations. We find it if the CBT is self guided or group based or one to one.

So, even though we don't know what phobia is and we don't know how the various therapies achieve their effect we do know that one works, and quickly, and the other doesn't.

But reading what you say I get the impression that it's all the same as homeopathy or acupunture - pure nonsense with no credible method of action and no science to support it.

If you'd accept that psychiatry, while being bad, is nkt as bad as homeopathy I'd have some agreement.