I am not sure that one can assume that. Julia Newton may not have wanted to waste time editing something produced by therapists designed to save the jobs of therapists when she herself seems to have largely withdrawn from ME research.
Those Newcastle comments had to have come from a therapist who really understands nothing about how you extract evidence from controlled observations.
I like the point that you cannot separate the effect of the personal relationship from the therapy. Which of course means that you cannot know if the therapy works - it might be the personal relationship. You cannot have your cake and eat it I am afraid!
I think you are right, and they may have revealed what's really going on. When patients report a benefit at clinics from a therapy, it's usually because they thought the therapist was nice or supportive.
One of the biggest early sources of "improvement" is the diagnosis itself (i.e., this leads to less confusion and uncertainty, and patients feel some relief, so they may report slightly better on questionnaires as a result).
That may not mean their illness was any better as a result, just that they enjoyed having a nice chat with someone who would listen to them and be sympathetic, and that they benefited from being taken seriously in terms of actually having an illness. (A low bar, I admit.)
Of course, there's a flip side: when that relationship breaks down, problems (aside from harms and unfulfilled expectations) might occur as a result.
If the patient doesn't see the therapist as nice or supportive (perhaps because they prefer actual treatment rather than a chat which they may not have the energy for), sympathy can quickly run out.
The patient becomes "one of the bad ones" instead of "one of the good ones" and the therapists might become accusatory and absolutist ("It's my way or the highway!"). Patients can feel abused or disbelieved as a result.
(I think societal bias against disabled people can play a part here, because therapists are just people too. There's a strong narrative of good disabled people who try hard and achieve, and bad disabled people who are scroungers, fakers or just weak.)
Some of the qualitative data I have looked at -- bearing in mind that the same therapists who were rated good by some are rated bad by others -- clearly shows this pattern: the patient wasn't deferential enough, or asked too many questions, and the therapist or clinic suddenly turned hostile. (Maybe their prejudice was reignited.)
Patients who nod, smile, lie and say they're complying with treatment, even when they aren't and/or it doesn't help, seem to fare better than those who outright say "no".
