Is psychotherapy effective?
More or less since the 1950s, empirical studies started to be carried out into a widely understood effectiveness of psychotherapy (Rakowska, 2005). They attempted to answer fundamentally three questions:
a. Is psychotherapy an effective method of treatment and/or supporting people struggling with mental disorders, particularly in comparison to pharmacotherapy?
b. What factors affect whether psychotherapy is or is not effective?
c. What is the effectiveness of individual schools of psychotherapy?
The discussion in this respect was started by an eminent personality psychologist, Hans Eysenck (1952), who carried out a meta-analysis of several dozen studies into psychotherapy effectiveness conducted at the time and came to the conclusion that a more or less the same number of psychiatric patients achieve improvement through psychotherapy and heal spontaneously without any psychotherapeutic intervention. However, literally hundreds of alter studies on psychotherapy effectiveness analysed in a lot of meta-analyses challenged the conclusions of Eysenck and provided reliable empirical data proving the fact that psychotherapy is not only an effective form of treatment of mental disorders, but also a method significantly supporting the development of humans and improving the quality of their lives (see e.g. Bergin, 1971; Elkin et al., 1988; Lambert, 1992; Luborsky et al., 1975; Smith and Glass, 1978). What is more, the turn of the 20th and 21st century brought fascinating discoveries from the border of psychotherapy and neurobiology indicating that psychotherapy can have an equally significant effect on the functioning of the brain as pharmacotherapy (see e.g. Etkin et al., 2005; Gabbard, 2000). As a result of the above, the World Health Organisation (WHO) regarded psychotherapy as an equally effective method of helping individuals with mental disorders as pharmacological treatment (WHO, 2001).
However, it proved more problematic to receive an answer to the two remaining questions, particularly the one concerning the comparison of the effectiveness of different schools of psychotherapy. Studies into this topic carry a risk of many methodological errors and traps, such as the so-called “loyalty effect” for one’s own school of psychotherapy (the researcher who represents the given psychotherapeutic modality wants to prove its superiority over other modalities) or the mirage of higher effectiveness on the given school of psychotherapy compared to another one resulting from the fact that the former conducts more empirical studies than the latter, which may not conduct such studies at all. Nevertheless, several dozen years of studies in this matter has not led to any specific conclusions barring the one that no school of psychotherapy is more effective than the other. What treats/helps in psychotherapy the most does not concern the so-called specific factors, understood as specific psychotherapeutic techniques characteristic of the given modality, but first and foremost the quality of the unique relation between the psychotherapist and the client (see e.g. Gelso and Hayes, 2004; Strupp, 1978).
In connection with a highly complex subject of psychotherapy, difficulties in pinpointing the criterion for its effectiveness (as in e.g. medicine) and interference of socio-cultural values in such studies, the paradigm of scientific investigation into psychotherapy changed at the beginning of the 21st century. It is accepted that studying the effectiveness of psychotherapy in general or between different schools is empirically unverifiable and leads only to futile disputes and standstill of scientific knowledge on whether and how psychotherapy works.
Instead, studies into the so-called psychotherapy microprocesses are being called for (cf. e.g. Altenstein et al., 2013; Koole, Tschacher, 2016; Wiltshire et al., 2020). It consists in analysing certain separate and delineated phenomena, e.g. concerning different individual traits of the psychotherapist and the client, and their effect on the dynamically changing relationship between them. Carrying out studies by separating single microprocesses allows creating a combined analysis of the process and outcome of psychotherapy while taking into account the individual differentiation of clients and psychotherapists – particularly on the arena of different psychotherapy modalities.
Altenstein D., Krieger T., Grosse-Holtforth M. (2013). Interpersonal microprocesses predict cognitive-emotional processing and the therapeutic alliance in psychotherapy for depression. Journal of Counseling Psychology, 60, 445–452.
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Wiltshire T., Philipsen J., Trasmundi S., Jensen T., Steffensen S. (2020). Interpersonal coordination dynamics in psychotherapy: A systematic review. Cognitive Therapy and Research, 44, 752–773.
World Health Organization (2001). The world health report 2001 – Mental Health: New Understanding, New Hope. https://www.who.int/whr/2001/en