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Polyvagal theory provided me with a coherent framework for understanding why cognitive insight alone often fails when a nervous system is in defensive dominance. In such states, higher-order cortical processes are functionally constrained.
The central clinical proposition of polyvagal theory-that autonomic state functions as an organizing platform shaping perception, emotion, and relational behavior-was not empirically disproven in the critique.
The ORS is a brief, 4-item measure designed to assess areas of life functioning known to change as a result of therapeutic intervention. It takes less than one minute to complete and score.
The SRS is a brief, 4-item measure designed to assess the therapeutic alliance. It provides immediate feedback on the quality of the relationship and allows for course correction in real time.
Likewise, self-diagnosis should be understood as an attempt to secure the therapeutic effect of a medical intervention to which patients do not have official access.
If a clinical diagnosis can have a therapeutic effect, then, at least in some instances, diagnoses are medical interventions in themselves and ought to be treated and researched as such, with an eye to both positive effects and potential iatrogenic harms.
Their experiences highlight a striking, neglected and unchristened medical phenomenon: The therapeutic effect of a clinical diagnosis, independent of any other intervention, where clinical diagnosis refers to situating the person's experiences into a clinical category by a clinician or the patient.
Recently I reviewed Adrian Kind’s 2025 book, “How Does the Psychiatrist Know?: On the Epistemology of Psychiatric Diagnostic Reasoning,” on this substack. I had mentioned that Kind’s book is the first systematic, in-depth, book-length philosophical investigation into how psychiatrists arrive at their diagnostic conclusions.
If one really wanted to know whether a treatment (e.g., CBT, IPT, ACT, EMDR) was more effective, it had to be directly compared to an approach intended to help - what Wampold and colleagues termed, a "bona fide" treatment. Doing otherwise, they argued, conflated artifacts of research design with actual research results.
Since 2012 when the first study appeared in the literature, others have been published documenting the tendency of practitioners to overestimate their effectiveness - on average, by 65% (1, 2).
It turns out that therapists who perform well on the FIS establish stronger relationships and are more effective (2). More to the point, the evidence shows FIS-related skills are trainable and that such training leads to better results (3, 4, 5).
Over the last 50 years, treatment methods have proliferated despite a lack of evidence of differential effectiveness between approaches. And even when a randomized controlled trial indicates a particular approach works, none show practitioners become more effective when they are trained in that modality.
Indeed, as I've reported in previous posts, research not only shows therapists do not improve with time and experience in the field, but on average become less effective (1, 2, 3, 4).
Take the free Attachment Style Quiz and get personalised insight into how you connect, where your patterns come from, and your next step toward secure love.
In my practice, I have seen that opening neural pathways can lead to profound change, to brand-new traits and behavior, sometimes in a matter of minutes.
I spoke with @mariamenounos about the link between emotions and illness, and the importance of focusing on mental health, on her Heal Squad podcast. To listen to the full episode, please follow: https://t.co/XPIKAvi8tH
A korrent is a belief a person has stated in their own words: one
sentence stating the claim, backed by a quote and a source, kept at
korrents.com.
Under a name here, the quoted block is what they actually said.
The korrent beneath it is the claim those words support, in
korrents' wording — tap it to see the record, its source, and who
else holds it.
Nobody here wrote their own korrents. They are compiled from public
statements, and a person can change their mind, which is recorded too.
About the English under a post
Some people here publish in a language other than English. Where they
do, this site shows a machine translation beneath the post, in
this typeface — the site's own, not theirs.
The post itself is never changed, moved or hidden: what is set in the
serif above is exactly what the person published, and it is what to
quote them on. A translation can be wrong in ways that matter,
especially about tone.
Only the post's own words are translated. A quoted post, a linked
article and a belief on korrents.com
are left in their original language.