The short answer is: yes. We know from scientific research that psychotherapy works. Years of careful scientific investigations have clearly demonstrated its effectiveness. Both qualitative and quantitative reviews of thousands of scientific studies have shown that about 75 to 80% of patients who enter psychotherapy benefit from it. This finding generalizes across a wide range of disorders and different therapy formats, including individual, couple, family, and group therapies.

The factors that make it work, however, are harder to explain. A review of the scientific research shows that the key factors for the success of psychotherapy are the relationship between therapist and client, and the customization of the treatment for the individual client. (Cuijpers, et al., 2008, Lambert, 2004; Karver, et al., 2006; Norcross, 2011; Shirk & Karver, 2003; Wampold, 2007 ).

The American Psychological Association (APA) created a task force to examine the factors that are causing the success of psychotherapy. (Norcross, 2011: Psychotherapy Relationships That Work: Evidence-Based Responsiveness (2nd edition.). Oxford University Press, USA). They examined the association between elements of the therapy relationship and treatment effectiveness through several meta-analyses. (A meta-analysis is a study of studies, a research method that aggregates the results of multiple studies on the same topic.) The effectiveness of therapy in these studies is measured by clients’ improved functioning, reduced suffering, physiological indicators, treatment retention, richer interactions with other people, work performance, and other indexes of recovery. The results of about 20+ meta-analyses converge into a series of research-supported conclusions with important consequences for psychotherapists and clients alike. Here are the findings they published: (In Norcross, J. C. 2011)

• The therapy relationship makes substantial and consistent contributions to patient success in all types of psychotherapy studied (for example, psychodynamic, humanistic, cognitive, behavioral, systemic).

• The therapy relationship accounts for why clients improve (or fail to improve) as much as the particular treatment method.

• Practice and treatment guidelines should address therapist qualities and behaviors that promote the therapy relationship.

• Practitioners should routinely monitor patients’ responses to the therapy relationship and ongoing treatment. Such monitoring leads to increased opportunities to repair alliance ruptures, improve the relationship, modify technical strategies, and avoid premature termination (Lambert, 2010).

• Efforts to promulgate best practices or evidence-based practices without including the relationship are incomplete and potentially misleading.

• The relationship acts in concert with treatment methods, patient characteristics, and practitioner qualities in determining effectiveness.

• A comprehensive understanding of effective (and ineffective) psychotherapy will consider all these determinants and their optimal combinations.

• Adapting or tailoring the relationship to several patient characteristics (in addition to diagnosis) enhances effectiveness (as summarized in chapter 13).

A study found that online psychotherapy is just as efficient as conventional therapy. Researchers at the University of Zurich have conducted a study in order to compare online psychotherapy with conventional face-to-face therapy. Six therapists treated 62 patients, the majority of whom were suffering from moderate depression. The patients were divided into two equal groups and randomly assigned to one of the therapeutic forms. The treatment consisted of eight sessions with different established techniques that stem from cognitive behavior therapy and could be carried out both orally and in writing. Patients treated online had to perform one predetermined written task per therapy unit — such as querying their own negative self-image.

Three months after the end of the therapy, patients with online treatment displayed fewer symptoms than patients treated face-to-face.

“In both groups, the depression values fell significantly,” says Professor Andreas Maercker, one of the investigators. At the end of the treatment, no more depression could be diagnosed in 53 percent of the patients who underwent online therapy — compared to 50 percent for face-to-face therapy.

Three months after completing the treatment, the depression in patients treated online even decreased whereas those treated conventionally only displayed a minimal decline: no more depression could be detected in 57 percent of patients from online therapy compared to 42 percent with conventional therapy.

For both patient groups, the satisfaction with the treatment and the therapists was very high. 96 percent of the patients given online therapy and 91 percent of the recipients of conventional treatment rated the contact with their therapist as “personal.”

In the case of online therapy, the patients tended to use the therapy contacts and subsequent homework very intensively to progress personally. For instance, they indicated that they had re-read the correspondence with their therapist from time to time.

“In the medium term, online psychotherapy even yields better results. Our study is evidence that psychotherapeutic services on the Internet are an effective supplement to therapeutic care,” concludes the study.

Discussion

The study is probably based on a sample that is too small. It would also be important to know how these patients were selected and instructed about the study. Did they have other therapy before or after the study was conducted, and how did the therapy methods compare between the online group and the in-person group? It’s the same problem with all psychotherapy research – questionnaires are not enough.

Nevertheless, the findings are a good starting point for a broader discussion. As the second article under “References” shows, web-based psychiatry (Telepsychiatry) is taking off, but it consist mainly in online consultations with a psychiatrist for medication decisions. Online psychotherapy is more difficult, but in principle just as good as in-person meetings. The advantage is that we can reach remote populations, and extent badly needed mental health services everywhere. The obstacle is the licensing process: as a therapist licensed in California, I am currently not allowed to treat a patient in New York via online technology. if it were allowed, it would greatly increase competition among therapists and licensing bodies. What would happen to New York therapists who charge $250 an hour? I hope the laws that regulate these new avenues for psychotherapy will soon get created.

References:

• Birgit Wagner, Andrea B. Horn, Andreas Maercker, Internet-based versus face-to-face cognitive-behavioral intervention for depression: A randomized controlled non-inferiority trial, Journal of Affective Disorders, 2013. DOI: 10.1016/j.jad.2013.06.032

• Web-based Counseling – Telepsychiatry – is taking off.

We know that psychotherapy works across all modalities for about 75 to 80% of all clients. The therapeutic relationship itself is key to the success of the process. Therefore, the next question is: What makes a good therapist? A review of the existing research was summarized by Bruce Wampold into the following traits of a good psychotherapist: Wampold, B. E. (2013). The Great Psychotherapy Debate: Models, Methods, and Findings (Counseling and Psychotherapy: Investigating Practice from Scientific, Historical, and Cultural Perspectives) (1 edition.). Routledge.

• Has a sophisticated set of interpersonal skills.

• Builds trust, understanding and belief from the client.

• Has an alliance with client.

• Has an acceptable and adaptive explanation of the client’s condition.

• Has a treatment plan and allows it to be flexible.

• Is influential, persuasive and convincing.

• Monitors patient progress.

• Offers hope and optimism (realistic optimism, not euphemisms).

• Is aware of a client’s characteristics in context.

• Is reflective.

• Relies on best research evidence.

• Continually improves through professional development.

Scientific research demonstrates that psychotherapy with an effective therapist works even better in the long-term and its effects are more enduring than medication. Psychotherapy is not only more cost-effective, but it leads to fewer relapses of anxiety or mild to moderate depression than medication use alone.

We live in a world saturated by advertisement. Pharmaceutical companies promise you quick fixes, and taking a pill is faster than seeing a therapist once a week for an hour. The evidence shows is that pills don’t work as well as therapy. Based on these findings, the Norwegian Health Authorities have already issued guidelines concerning the treatment of mild to moderate depression and anxiety, and they suggest that psychological interventions, not medications, should be applied first.

Psychotherapy should be the preferred treatment for most non-psychotic conditions, but major pharmaceutical companies heavily market their medications directly to the public and to health professionals, which creates false expectations in clients, and a strong demand for chemical fixes in people affected by anxiety or other emotional problems. Therapy gets sharper, more effective, and more enduring, but it continues to lose influence in the mental health field to medication-based approaches, which are also propagated by psychiatrists.

The goal is to make psychotherapy a first-line treatment for people who seek help. Eventually, people will realize that eating pills is not a solution to their life problems. Finding a good therapist can really be a life-changing event.

• American Psychiatric Association - The American Psychiatric Association, founded in 1844, is the world’s largest psychiatric organization. It is a medical specialty society representing more than 33,000 psychiatric physicians from the United States and around the world.

• American Psychoanalytic Association - This website contains many useful articles about psychotherapy, and gives an overview of psychoanalysis in America.

• American Psychological Association - The American Psychological Association is the largest scientific and professional organization representing psychology in the United States. APA is the world's largest association of psychologists, with more than 134,000 researchers, educators, clinicians

• Counseling California - Resources for Clients. - Information for Patients and people who seek psychological help. Good information resource, as well as a directory of qualified marriage and family therapists in California.

• Ethical Standards for Psychologists - The official page from the American Psychological Association, APA.

• My Academic Website.

• The British Psychological Society - Explains scientific psychology and the field of psychotherapy.