Therapy and materialistic accounts of behavior

I used to see a therapist. Every week they would give me actions to take in the coming week. For instance, fill out a sheet about panic attacks immediately after any panic attacks that I had. Or, do a mindfulness exercise about once per day, at a time when I was anxious. 

It seemed to me that it order for any of these things to happen with high probability, I would need to immediately do something to cause them to happen. For instance, think about what symptoms of anxiety should trigger the mindfulness exercise and try to imagine them happening and exactly what I hope to do then. Or make a note to put the panic attack sheet under the honey that I eat if I’m having a panic attack. Or at least make a note in my todo list to figure out how to make these things happen later. 

Being somewhat anxious is just not sufficiently salient and distinctive that I’m going to think ‘oh hey, anxiety—what do I do now?’ And whatever it is that the therapist wanted me to do is also not sufficiently memorable or unique that I will think of it. This may sound implausible, but remember that I have several other things going in life besides paying attention to my own anxiety, many of which also involve paying attention to things, or doing things. And my therapist is far from the only source of suggestions on what I should do if I’m anxious. So just being told to do another thing one time is probably not going to make it happen.

Furthermore, if I’m actually having a panic attack, it’s a good day if I can remember to do the things that I know make it better, let alone fill out some form that’s in my bag somewhere. (Panic attacks can be associated with an extremely perceptible decrease in one’s shit being together.) So getting these weekly exercises to happen would require some actual thought.

This worldview seemed foreign to my therapist. They seemed to think that if I agreed to do a thing, then I would magically do it. Like a story character running on narrative coherence, not like a machine running on causality. 

Often I did not do the things, or did them at the wrong times. Usually because it didn’t occur to me at the relevant time, in line with my theory. (Really I should have had a standing plan to think about these things immediately after therapy each time, but I didn’t.) My therapist would emphasize to me that it is important to do the things at the right times. 

This seems like a surprising kind of failure for a therapist, assuming it is a failure. For one thing, if anyone is going to be aware that human minds don’t run on narrative magic, it should probably be psychological professionals. For another, if anyone should benefit from knowing that human minds don’t run on narrative magic—and in particular that they often need further setup in order to do a thing in the future—it should probably be that whole set of professionals who regularly try to get other random untrained humans to do specific stuff in their own time. Doctors, dentists, teachers, therapists, etc. 

I don’t know if I’ve ever seen a doctor, dentist, teacher, or therapist try to cause me to have a real, actionable plan to do something. Perhaps other people’s minds don’t need this kind of thing? My understanding is that the failure of humans to do what medical professionals ask them to do is a major headache for medical professionals. Also, I’d be surprised if I’m among the least conscientious of the people with imperfect mental health. Others’ failures to follow instructions might be for different reasons. But I think the ‘trigger action planning’ stuff at CFAR is pretty well liked, and it is basically this. 

Is this worldview—on which deciding to do a thing will not magically cause you to do it—just rare outside of the rationalist community? Have I just randomly bumped into people who don’t have it? Is it actually just not useful to therapists and other such people? Is it actually just not useful to anyone? 

6 responses to “Therapy and materialistic accounts of behavior

  1. I think it is rarely acknowledged outside of the rationalist community.

    I also think doctors, teachers and therapists are all the type of people who have a robust planning /calendar /remembering strategies and are unaware that they do, then commit Typical Mind and think that anyone who does not their one is lazy.

    Creatives and empathy people (younger siblings) have less good calendar type talents but have much better creative /empathy talents. But to make it through med school you have to be sciencey / rational / future oriented / NOT empathetic / older sibling type person.

  2. David Allen’s GTD system implies the need for such a thing. Basically he says repeatedly that you need to have a system that does not require you to remember anything that needs to be done.

    However, I think the common reason for not doing this is that simply saying, “I am going to do this,” is in fact sufficient to do it, if you care enough about doing it. What your therapist was really saying was probably something like, “you need to care more about doing this.”

    For most people, such plans are unnecessary because when they do not do the thing, that automatically tells them that it doesn’t matter, because they did not care enough about it anyway.

    Of course, the problem with that is that if you don’t care that much about, but want to care about it, you can’t simply make yourself care more by deciding to do so. And in those contexts such plans are useful.

  3. Guy Srinivasan

    I have not had a therapist with that failure mode. 0/3. Actually I may have had one, but I stopped seeing him after 2 sessions. So maybe 1/4.

    Everyone has been very on-board with “you’ll need to do this action when you experience this thing, so first you’ll need to practice consciously noticing when you experience this thing”.

  4. It’s not a “headache” for medical professionals. When a medical professional tells you to do something, they’re simply covering their ass. If you don’t do it, it’s not their fault or problem.

  5. I think my Best Version of Being A Therapist (ie, the thing I wish I did with every single client) is figure out what the earliest possible sensation they notice, (for instance, abrupt stomach pains) and then to document their thoughts around those abrupt stomach pains, with acceptance of a false positive rate. It takes some buy in (“you want me to write down my feelings EVEN if it’s obviously food poisoning??”) otherwise seems more possible.

    This happened less regularly because I tended to work with people who didn’t often notice their emotions or triggers, so I wasn’t instituting thought records frequently.

  6. My eye doctor told me to treat some minor eyelid problem by holding a hot compress to it for 30 minutes a day, 3 times a day, for several months. It didn’t seem to occur to him that basically nobody has time for this. More likely he sees his role as suggesting something to do that might help, even if that thing is clearly not worth the opportunity cost.

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