The American Psychologist Journal (vol. 50: No. 12, 1995) published the results of a Consumer Reports survey, asking approximately 7,000 people about the mental health treatment they’d received. Respondents tended to be educated, middle class, about one half were women, with a median age of 46 years. The majority were “highly satisfied” with their psychotherapy, and almost all said that their lives were improved and relationships felt more “manageable”.
Some key findings:
- People who received only psychotherapy improved as much as those who received psychotherapy with medication.
- Almost ¾ of the respondents went to a mental health professional (rather than clergy, family doctor, etc.).
- The longer people stayed in therapy, the more they improved; those who stayed for a minimum of six months progressed the most.
- People who started therapy feeling the worst reported the most progress.
- No specific modality or type of therapy did better for client improvement.
- Clients whose length of therapy or choice of therapist was limited by insurance or managed care did worse.
- Active “shoppers” did better than passive clients, e.g. those who sought out a therapist for themselves, rather than rely on a significant other to set up the initial appointment. Though this is a self-report measure and has inherent flaws, researchers agree that the survey merits serious consideration because it complements the traditional efficacy methods.
Additional findings on the effectiveness of psychotherapy include:
- A 2010 study (Emotion; April 10: (2), demonstrates mindfulness training (in psychotherapy) reduces vulnerability to depression, ease recovery from emotional challenges, and increases tolerance to “negative” emotions, e.g sadness and anxiety. The methodology compared two groups of functional MRI’s–participants’ neural reactivity who practiced MT for 8 weeks–compared with those who did not. Mindfulness training is defined thus: while developing an observing stance, teach awareness of the present moment.
- A 2008 study published in the Journal of Consulting and Clinical Psychology (vol. 76 (1), 116-124) evaluated therapy effectiveness for treating adult clinical depression. It indicated major improvements in functioning for all indices: mood, motivation, concentration, appetite, fatigue, and sleep.
- A 2006 article in the Journal of Psychotherapy: Research Practice, Training (vol. 43 (2) 216-231) studied clients with predominantly anxiety symptoms. Clients’ responses to varied therapies were measured and compared; essentially, clients achieved “significant gains” and made changes from all theoretic orientation – cognitive/behavioral, psychodynamic, and interpersonal. They also maintained progress at a six month follow-up.
- A 2008 Oxford Journals (Abbass, Joffres, and Ogrodniczuk) published an article studying the effectiveness of short-term dynamic psychotherapy. The interviews and inventories post-therapy revealed statistically significant improvements: one third required no further treatment; seven clients stopped medication; two clients returned to work.
- The 2006 edition of Research on Social Work Practice (vol. 16, no. 2, 166-175) investigated whether or not clients improve, and if so, what therapeutic variable is efficacious. The results suggest not only that therapy is effective, but that the specific modality studied – psychodynamic interpretation – helped clients achieve their goals.
These research findings are a fraction of thousands of available studies . . . with all this compelling research on the utility of psychotherapy it is reasonable to ask: when does psychotherapy not work?
This is a good question because I don’t want to glorify the practice of psychotherapy, extolling its virtues without fairly critiquing it. In fact, we do have evidence for when therapy does not work: the 2001 issue of Psychotherapy: Theory, Research, Practice, Training (vol. 38 (2), 171-185), reports a review of psychological literature from 1988 to 1999, examining therapist’s personal attributes and in-session activities, negatively influencing therapy alliance and outcome. Therapist’s qualities contributing negatively are: rigid, tense, distracted, hurried, distant, and critical. Techniques such as over-structuring the sessions, inappropriately using silence and self-disclosure, making transference interpretations in an unyielding, dogmatic fashion; these proved not conducive to a positive therapy outcome and created or exacerbated problems with alliance.