After 75 years of psychotherapy research, many questions remain. . .
How and why does psychotherapy work? 75 years of scientific study show that psychotherapy works much better than no treatment at all. Yet, to date, we have very little understanding of why. If some therapies worked better than others, it would help move the science along—because then we would understand how active ingredients associated with particular therapies may differ from one another. Unfortunately, well designed large studies have shown repeatedly that psychotherapies are all equally effective.
It is sometimes suggested that highly structured therapies, like Cognitive Behavioral Therapy, work better than other therapies. But in fact, a close look at these studies suggests that this widely believed fact may be a mirage—a kind of large-scale misperception that is surprisingly common in the scientific literature! An important point to understand is that when it comes to mental health treatment, the dominant and prestigious therapies of the moment always seem to do better than older, or less ‘popular’ treatments. This is due in part to a phenomenon called the ‘Champion Effect’—if the project leader and champion is associated with a particular type of treatment in a clinical trial, that treatment always does better than the comparison condition!
Weird, huh?
In fact, what the science really tells us is that it is probably the non-specific factors in therapy—the relationship that grows during treatment and the support and understanding offered by the therapist—that really works. Studies show that while treatment type makes no difference in outcome, the therapist makes a huge difference! Surprisingly, therapists differ drastically in quality. Therapists who offer support, are non-critical, who are able to apologize when they make mistakes, tend to have better outcomes with their patients. Yet to date, the science of psychotherapy has not really focused on these issues. If it did, training programs would look a lot different.
I really like Scott Miller. In this blog piece, he talks about why the science of psychotherapy is moving forward so slowly. Research keeps focusing on specific techniques that really have almost no real relationship to outcomes. Scott suggests some solutions.
https://www.scottdmiller.com/time-for-a-new-paradigm-psychotherapy-outcomes-stagnant-for-40-years/
