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The myth of the extremely effective therapist

Paul Ingraham ARCHIVEDMicroblog posts are archived and rarely updated. In contrast, most long-form articles on PainScience.com are updated regularly over the years (see updates page).

If you are suffering from serious chronic pain, please do not look for a “pain whisperer.” It’s nearly impossible to tell the difference between a genuine expert and a charming bullshitter. The idea of the exceptional clinician is mostly a pernicious myth anyway: most chronic pain is much too multifactorial and mysterious for any clinician to have consistently superior results.

Yes, some people were at the top of their class, and some actually are unusually talented … but they are rare, and they are not really much better at treating chronic pain than anyone else. Health care is not like sports, with an elite class of gifted people that consistently win. It’s more like gambling or investment, where uncontrollable variables dominate the equation, and the elite are defined more by their restraint and wisdom than special skills or insight. If a professional is truly knowledgeable and talented, then his or her true superpowers will mostly disappoint the desperate: restraint, humility, good communication, and doing no harm with bogus diagnoses and treatments.

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