> Isn't all psychotherapy in a way just a placebo?
Absolutely not.
It is one thing to just give someone a sugar pill or a random ritual and tell them "this will make you feel better". That's placebo. (Not saying it never works, just that's the definition of placebo.)
It is another thing completely to help people realize which thought patterns and which conscious focus and which memories keep them stuck in old loops. Which subconscious patterns and habits make them miserable. Which parts of their current world model are not working for them and help them actually transform the way they think about themselves, view themselves, feel themselves, the way they operate in the world on a day-to-day basis. That's psychotherapy. It is literally changing the software of the human mind.
Now there might be fake psychotherapists out there who don't know what they are doing and are limited to the effects of placebo in their practices. But that does not mean that one thing is the same as the other.
I can also see how there could be cases where a person receives a placebo, for some reason (the magic behind placebo) it makes them feel exceptionally well, and they use this push of energy to transform some part of their worldview on their own and so they keep some long-term effects of it. This doesn't either make one thing the same as the other, and it does not happen so often either.
You've linked to the dodo bird hypothesis, but the dodo bird hypothesis does NOT claim that all psychotherapy is placebo. It claims that all or nearly all established evidence-supported treatments given by trained professionals produce very similar outcomes.
If you read deeper in the page you linked on the subject, it goes on to the actual conclusion that the common factors of psychotherapy - empathy, positive regard, strategic alliance, and others - are predictive of psychotherapeutic outcome across therapies. In addition, it is shown that many key features of modern psychotherapies including awareness of one's thoughts and emotions are essentially universal therapeutic components.
In the book on the subject by Wampold and Imel, they found real and significant difference between therapists on their ability to produce outcome based on these common factors. So while modern therapeutic models may be indistinguishable in terms of outcome, modern therapists are not. And there IS such a thing as better vs worse therapy. And this is an ongoing research area.
To be more explicit: it's a bit of an issue of definition.
I was going by the rule of thumb that whatever your homeopath or acupuncturists would also do, would count as placebo from the point of view of psychotherapy.
And, yes, those people employ many of the same common factors. And different people have different amount of skills in employing those. (Or creating different outcomes in general.)
If you want to call that placebo or not, is up to you.
There's also very interesting research into what makes effective placebos, and how eg cultural context influences that.
From what I've read (sham) surgery is more effective than an injection which is more effective than a pill. And more expensive placebos are more effective than cheaper ones.
If memory serves right, whether big or small pills have a bigger effect depended on country. (The hypothesis was that some cultures believed smaller pills are more highly concentrated, whereas others believed bigger is better.)
> It's not completely clear whether there are any psychotherapies that are better than placebos.
What can be said for sure, and which was my original point, is that regardless of which one is "better", they are not the same thing at all. They are two very different distinct concepts that describe two very different existing phenomena.
Incidentally, it is very clear to me, based on my life experience (and that includes using critical thinking to approach life) and experience of many other people I've met that in most cases real psychotherapy is quite effective, unlike most uses of placebo. Although there seem to be cases of placebo that are exceptionally effective too, so who knows?
This is of course just an anecdote and I don't have any studies at my fingertips right now that somehow calculate and compare the relative effectiveness of the two. I would imagine that using and especially scaling placebo in effective manner is difficult because it relies on active ignorance of the user.
In some sense the broader question is what about psychotherapy actual does the work.
So when I mentioned talking to some random high status individual who lends a sympathetic ear, that's one way to separate the factors.
Another one, with lots of practitioners, is looking at pastors and other religious figures. Pastoral care is a big deal. Whether you want to treat that as placebo or a special kind of psychotherapy is a judgement call.
If these examples work just as well (or badly) as Freudian psychoanalysis, then that's good knowledge to build on.
Perhaps they work better or worse than Freudian psychoanalysis. That's also useful to know.
Placebos are actually as effective as many approved pharmaceuticals (you should see the statistics games, and nonrandom samples used in the majority of clinical trials).
Absolutely not.
It is one thing to just give someone a sugar pill or a random ritual and tell them "this will make you feel better". That's placebo. (Not saying it never works, just that's the definition of placebo.)
It is another thing completely to help people realize which thought patterns and which conscious focus and which memories keep them stuck in old loops. Which subconscious patterns and habits make them miserable. Which parts of their current world model are not working for them and help them actually transform the way they think about themselves, view themselves, feel themselves, the way they operate in the world on a day-to-day basis. That's psychotherapy. It is literally changing the software of the human mind.
Now there might be fake psychotherapists out there who don't know what they are doing and are limited to the effects of placebo in their practices. But that does not mean that one thing is the same as the other.
I can also see how there could be cases where a person receives a placebo, for some reason (the magic behind placebo) it makes them feel exceptionally well, and they use this push of energy to transform some part of their worldview on their own and so they keep some long-term effects of it. This doesn't either make one thing the same as the other, and it does not happen so often either.