Does Psychotherapy work?
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 (See references in the link section below.)
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:
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.
Online or face-to-face?
I offer both modalities. Since the days of Covid, most therapy has migrated to video platforms, because it is so convenient, and it also works pretty well. Traditional in-person therapy involves face-to-face sessions, and fosters strong therapeutic alliances through direct interaction and non-verbal communication. It is highly effective due to the immediate feedback and structured environment it provides.
Teletherapy, conducted via video conferencing, offers increased accessibility and flexibility, and is especially beneficial for those in remote areas or with mobility issues. Research indicates that video therapy can be as effective as in-person therapy, with high patient satisfaction and strong therapeutic alliances reported.
References:
National Institute of Mental Health - Telehealth and Teletherapy: The NIMH discusses the benefits and effectiveness of telehealth services, including teletherapy, especially in increasing access to mental health care. More information at NIMH.
American Psychological Association - Telepsychology Effectiveness: The APA provides an overview of studies showing that telepsychology is effective for a range of mental health issues, comparable to in-person therapy. Read the APA article.
Springer - Effectiveness of Psychological Interventions in Routine Practice: This meta-analysis highlights that teletherapy is as effective as traditional in-person therapy for treating conditions like depression and anxiety. Read more at Springer.
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
Getting the most out of Therapy
Psychotherapy may not cure your condition or make an unpleasant situation go away. But it can give you the power to cope in a healthy way and feel better about yourself and your life. Here are a few tips to get the most out of the process:
1. Build a Strong Therapeutic Alliance
Engage Actively: Building a good relationship with your therapist is crucial. Engage actively in sessions, be open, and provide honest feedback.
Research Support: Studies show that the therapeutic alliance is one of the strongest predictors of positive outcomes in therapy (Horvath & Bedi, 2002). Read more at APA.
2. Set Clear Goals
Define Objectives: Work with your therapist to set clear, achievable goals for what you want to accomplish in therapy.
Research Support: Goal-setting in therapy has been linked to better treatment outcomes and increased motivation (Schippers & Ziegler, 2019). Explore the study.
3. Practice Skills Outside Sessions
Apply Techniques: Practice the skills and techniques learned in therapy in your daily life to reinforce your progress.
Research Support: Homework assignments and practicing skills outside of sessions have been shown to enhance therapeutic outcomes (Kazantzis et al., 2010). Learn more.
4. Communicate Openly
Express Concerns: Don’t hesitate to express any concerns or discomfort you might feel about the therapy process or your progress.
Research Support: Open communication helps in adjusting the therapy to better fit your needs, improving its effectiveness (Swift & Greenberg, 2012). More information.
5. Stay Committed
Consistency Matters: Regular attendance and commitment to the process are key to making significant progress in therapy.
Research Support: Consistent therapy attendance is associated with better outcomes and long-term improvements (Lambert, 2013). Read more at NCBI.
6. Be Patient and Persistent
Allow Time: Understand that therapy is a process that takes time and persistence.
Research Support: Long-term benefits of therapy often emerge over time, and persistence can lead to lasting change (Wampold & Imel, 2015). Explore further.
What makes a good Therapist?
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:
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 quick fixes, and taking a pill is faster than seeing a therapist once a week for an hour. The evidence shows that pills don’t work as well as therapy, particularly for mild to moderate mental health conditions. Based on these findings, it is advisable that psychological interventions, not medications, should be applied first.
Reference:
(Wampold, B. E., & Imel, Z. E. (2015). The great psychotherapy debate: The evidence for what makes psychotherapy work (2nd ed.). Routledge/Taylor & Francis Group.)
The legal and ethical Framework
Psychotherapy is governed by a complex framework of rules and regulations. As a medical procedure reimbursed by health insurance, it operates within a legal and bureaucratic structure. For psychotherapy to be effective, therapists must adhere to specific guidelines, such as limiting self-disclosure and avoiding dual relationships with clients.
The ethical foundations of psychotherapy are rooted in centuries-old healthcare principles, beginning with the ancient Greek Hippocratic Oath. This oath emphasizes respect for human life and treating the whole person, not just symptoms. The code of conduct for psychotherapists expands on these principles, recognizing that as a "talking cure," psychotherapy requires an ethics of speech.
In psychotherapy, ethical adherence is not merely an external requirement but an integral part of the therapeutic process. Ethical guidelines serve as the foundation for psychotherapeutic methods and techniques, directly influencing the treatment's success.
The practice of psychotherapy requires a seamless integration of scientific, therapeutic, legal, and ethical principles. These guidelines inform all aspects of treatment, from therapeutic choices to practical arrangements. The fundamental principle underlying psychotherapy is the recognition that the therapist-patient relationship itself serves as a vehicle for important feelings, thoughts, and beliefs. Consequently, this relationship must be carefully established and protected.
Key ethical considerations include:
Confidentiality: Essential for building trust and ensuring positive therapeutic outcomes.
Boundaries: Protect the therapeutic process and allow the relationship to develop effectively.
Informed consent: Ensures patients understand the nature and purpose of the treatment.
Cultural competence: Recognizes and respects diverse backgrounds and experiences.
Understanding and implementing these ethical guidelines is crucial for the therapeutic relationship to evolve and for the treatment to succeed. They provide a framework that protects both the client and the therapist, ensuring a safe and effective therapeutic environment.
The American Psychological Association's Code of Conduct for Psychologists serves as the most authoritative resource for ethical guidelines in the field. This comprehensive document outlines professional standards, helping therapists navigate complex ethical situations and maintain the highest level of care for their clients.
Useful Links
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
Ethical Standards for Psychologists - The official page from the American Psychological Association, APA.
The British Psychological Society - Explains scientific psychology and the field of psychotherapy.
Research on Psychotherapy
Here are some valuable sources and summaries on the effectiveness of various psychotherapy methods, including psychodynamic and humanistic approaches:
Effectiveness of Psychological Interventions in Routine Practice: A meta-analysis shows that psychological therapies are effective, with therapist qualities and the therapeutic alliance playing key roles. Read more at the National Library for Medicine.
Online Psychotherapy and App-Supported Therapy: Research finds online therapies effective for depression and anxiety, offering high client satisfaction and cost-effectiveness. Learn more from Springer.
Practice-Based Evidence in Psychotherapy: This approach emphasizes adapting therapies to individual needs and integrating clinical expertise, bridging research and practice. Explore further at SpringerLink.
Role of Expectations and Therapist Qualities: Positive expectations and a strong therapeutic alliance are crucial for successful therapy outcomes, with empathy and cultural sensitivity being key factors. Read the full article at Psychology Today.
Effectiveness of Psychodynamic Therapy: A comprehensive review of studies shows psychodynamic therapy (PDT) is effective for various conditions, including mood and anxiety disorders, often matching cognitive behavioral therapy (CBT) in outcomes.
Fonagy, P. (2015). The effectiveness of psychodynamic psychotherapies: An update. World Psychiatry: Official Journal of the World Psychiatric Association , 14(2), 137–150.
Sears, R. (n.d.). Accumulating Evidence for the Effectiveness of Psychodynamic Therapy. Retrieved June 25, 2024, from https://www.madinamerica.com/2023/10/accumulating-evidence-for-the-effectiveness-of-psychodynamic-therapy/
Psychodynamic Therapy for Depression: Studies indicate that psychodynamic therapy is as effective as other treatments for depression, with particular benefits in understanding and resolving underlying psychological issues. More details at Cambridge Core.
Evidence in Support of Psychodynamic Psychotherapy: A detailed compilation of research supporting the effectiveness of psychodynamic therapies for various mental health issues. Read the report at BPC.
These sources collectively highlight the efficacy of different psychotherapy methods, emphasizing the importance of therapist skills, therapeutic alliances, and adapting treatments to individual needs.