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)