Does psychotherapy work?

Presented just to think about from the New York Time Sunday Book Review is the article, “Still crazy after all these years.” It’s about psychotherapy and whether it works. Frankly I think it’s a largely hit or miss enterprise. It certainly changes the lives of some but clearly does nothing for so many as well.

Below I excerpt the beginning of the article.

Does psychotherapy work?

Depends on what you mean by “psychotherapy.” And by “work.”

The answer matters. In trying to ascend from (as Freud once put it) “hysterical misery to ordinary unhappiness,” millions of Americans attend weekly therapy sessions of myriad kinds, at costs that can exceed $10,000 a year. Large professional edifices — psychiatry, psychology, social work, among others — are constructed atop the notion that psychotherapy works. If it were to be conclusively demonstrated that therapy doesn’t work, therapists would be put out of business; that’s effectively what’s already happened to Freudian psychoanalysts.

Jonathan Engel, a professor of health care policy at Baruch College, begins “American Therapy” by asserting: “Psychotherapy works. Multiple studies conducted over the past half-century have demonstrated that two-thirds of people who engage in psychotherapy improve.” But then, intentionally or not, he dedicates the better part of this fascinating book to complicating that proposition.

For starters, there’s that one-third of patients who don’t get better with psychotherapy; by definition, it doesn’t work for them. And then, perhaps more damningly, there’s the one-third of patients who have been consistently shown to get better without any treatment at all.

And then there’s this: a survey published in the early 1970s found that whereas a majority (59 percent) of people who had visited a professional psychotherapist for mental distress reported having been “helped” or “helped a lot” by the consultation, much larger majorities of people who had consulted a clergyman (78 percent) or a physician without specialized psychological training (76 percent) or — get this — a lawyer (77 percent) reported the same thing. Of course, psychotherapy did develop some pretty wacky offshoots in the 1970s — primal scream therapy, rebirthing therapy and Z-therapy (which seems to have involved, among other things, poking and tickling the patient) — so maybe it’s not surprising that people got more psychic relief from their lawyers than their therapists. But while a 1974 paper by a Johns Hopkins psychiatrist criticized the “charlatans” who “preyed on the gullible and the self-deluded,” these kooky therapies were actually surprisingly effective; many of the patients who underwent them reported themselves cured. This would certainly seem to undermine the claims of mainstream professional psychotherapy to specialized knowledge of any particular usefulness. If someone can poke and tickle a neurotic patient to health, why should an aspiring psychotherapist bother to get a graduate degree? Is psychotherapy just a high-priced placebo? (continue article)

5 thoughts on “Does psychotherapy work?

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  1. It may help some people, but it’s unregulated and completely unscientific. Patients who ask for clear goals and timelines to work to are often dismissed as “neurotic”. The success rate for treating depressionn is 19% – 30&. In other words, it usually doesn’t work.

  2. This is too biased for me:
    “The death warrant may actually have been written earlier, in the 1950s, on the first prescriptions for Thorazine, an anti­psychotic medication so effective that it became known as “the drug which emptied the hospitals.” Though Freud himself anticipated the age of biological psychiatry (in 1938, he wrote “the future may teach us to exercise a direct influence, by means of particular chemical substances, on the amounts of energy and their distribution in the mental apparatus”), the realization that drugs could so successfully treat some forms of mental illness thoroughly discombobulated the psychoanalytic profession. If drugs worked, that implied an organic, or medical, basis for neurosis, which in turn challenged some of the basic assumptions of psychoanalytically oriented therapy. If mental illness was due to some physical anomaly in the brain, wasn’t the best way to treat the illness by directly addressing that anomaly, with a pill? By the mid-1960s, the psychiatric establishment was moving definitively in a pharmaceutically oriented direction.(emphasis mine)

    Meanwhile, the advent of even better drugs like Prozac (which went on the market in 1987), and the proliferation of cognitive therapies, in which the patient works with a therapist in a focused way to change maladaptive ways of thinking, further diminished Freud’s standing; repeated controlled studies clearly showed both drug and cognitive therapies to be effective in ways that psychoanalysis, with its hours on the couch, has not been shown to be.Though some Freudian analysts continue to practice today, Engel writes, they resemble “nothing more than a fanatical Essene sect, living apart in the wilderness where they could continue to seek truth in the master’s writings.” “(emphasis mine)

    The photo that is in the article is ridiculous.
    Psychiatry has banned the term “neurosis” because it would too hard to prescribe…
    This kind of description of psychoanalysis sounds too pro-Pharma to me.

    Yes Jim!
    AA works for alcoholism and I don’t think that any therapy can help as much as AA does.
    But I hate to see psychoanalysis being described as charlatanism of a bunch of greedy professionals.
    It’s not like this at least here in Brazil and the pro-biological love to write articles like this. Unfortunately the media don’t publish anything from therapists.
    I don’t hear too much from psychoanalysts in US.
    It’s a long discussion.

    1. hey Ana,
      I didn’t even read the whole article…
      but yeah, you know I don’t like a pharmaceutical approach for sure…

      the thing is I do think most therapy is poorly informed and useless.

      not to deny that some good work happens…no not at all.

  3. This article makes a lot of sense to me. I have seen hundreds of people recover from alcoholism by going to AA. The people in AA on not trained, many were homeless at one point, yet they have wisdom that doctors lack; one reason AA works is that its based on one alcoholic talking to another. Doctors are too busy with forms and conmputers to talk to their patients.

    I also have seen many get help through self-help groups like Recovery, Inc. The leaders have some training, but their chief qualification is that they once suffered from mental illness themselves.

    Thank for posting this interesting article.

    Jim S

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