Psychotherapy has been around for more than a hundred years and gradually became a standard of care in mental health.
But does it work?
According to the National Institute of Mental Health, around 30 million people each year receive mental health services. How many of these 30 million people is psychotherapy actually helping?
Since the 1950’s, psychotherapy has been subjected to the ruthless objectivity of science. The results of the earlier studies were dismal. Psychotherapists seemed to be doing nothing more than keeping people company. In response to these disappointing findings, researchers and psychotherapists worked together to raise their standards, tighten their methods, and improve their interventions.
A lot of evidence has been accumulated since then that supports the claim that psychotherapy is effective. But the truth is that not all psychotherapy works, it doesn’t work all the time, and it doesn’t work for everyone.
Psychotherapy fails to deliver on its promises for three reasons:
1. The intervention is ineffective
The bulk of psychotherapy research focuses on the intervention. Interventions are the techniques that therapists use in session to bring about results. There is a broad range of interventions, some of which are similar and some vastly different. In addition, some interventions are very specific, like eye movement desensitization and reprocessing, which involves following the therapist’s fingers with your eyes while thinking of a traumatic experience. Other interventions are general, like life review therapy, which involves reconstructing your life story, including both positive and negative events. If psychotherapy doesn’t work, the intervention is considered ineffective. If it does work, the intervention enters the hall of fame of evidence-based practices.
2. The client is reduced to a diagnosis
There is only one aspect of the client that psychotherapy research routinely focuses on: the diagnosis. In order to be methodologically more accurate, a study needs to identify as narrow a “target market” as possible. A mental disorder diagnosis makes it easy to identify people similar enough on whom to test the intervention. The assumption is that people with the same diagnosis will respond the same way to the intervention. But clients are much more than their diagnosis. Their health, personality, life circumstances, and their expectations and approach to treatment will have a much stronger influence on outcome than their diagnosis. When researchers take into account only the diagnosis, and a few other easy-to-measure variables, like gender, age, and race, they will never know what else makes psychotherapy work or fail.
3. The role of the therapist is ignored
Not all therapists are the same. In fact, therapists differ in many more ways than they are similar. From demographic characteristics like gender and age, to professional training and experience, interpersonal skills, emotional stability, belief system, and personalities, therapists come in all kinds. Psychotherapy research, however, operates on the assumption that if you give therapists a script and train them how to deliver it, all the other differences among them will equalize. Only the intervention should determine psychotherapy outcomes. Therapists may be very adept at delivering the intervention but their other characteristics may have a much stronger effect on treatment. As a result, rarely is the therapist blamed when psychotherapy doesn’t deliver results.
The conclusion? For psychotherapy to be successful the client, the therapist, and the intervention must fit well together. If any of these three components of psychotherapy is a mismatch with another, therapy is bound to fail.
The bigger question that remains unanswered is what successful psychotherapy really means. What does it mean to you?