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.

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 (see below)[ref]Lambert & Ogles, 2004 ; Wampold, 2001[/ref].

The American Psychological Association (APA) created a task force to examine the factors that are causing the success of psychotherapy[ref]Norcross, 2011: Psychotherapy Relationships That Work: Evidence-Based Responsiveness (2 edition.). Oxford University Press, USA.[/ref]. They examined the association between elements of the therapy relationship and treatment effectiveness through several meta-analyses.[ref]A meta-analysis is a study of studies, a research method that aggregates the results of multiple studies on the same topic.[/ref] 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:[ref] In Norcross, J. C. (2011).[/ref]

  • 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).

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