Question

Does psychotherapy work & how might psychotherapy work?

Answer 1

[Psychotherapy is an interpersonal process in which therapists communicate to patients that they understand them, respect them, and want to help them. Most procedures used by trained professionals to treat people with psychological problems involve understanding, respect, and helpfulness. The difference in psychotherapy is the intentional effort of therapists to communicate their understanding of a patient’s difficulties and help him or her share in this understanding. Other mental health treatment methods like drug therapy, behavior modification, and environmental manipulation also convey to patients that their problems are being understood. But this implicit communication is only a peripheral feature of the method, intended primarily to facilitate the psychotherapeutic effects of the drugs, behavior shaping, and environmental manipulations. In psychotherapy the communication of person-related understanding is explicit and constitutes the central feature of the method .

Sophisticated use of somatic, behavioral, and environmental therapies usually includes some explicit communication to patients of where their difficulties appear to lie and in what ways the treatment procedures are expected to prove helpful. When therapists communicate this kind of understanding to their patients and involve them as active agents in the treatment, they are providing psychotherapy. In contrast, when therapists shift their focus from the communication of person-related understanding to telling their patients what to do or altering their body chemistry or environment, they are engaging in treatment procedures that are not psychotherapy, even though these procedures may also be psychotherapeutic. The professional psychotherapy relationship is not a mutual relationship. In psychotherapy, the interests, needs, and welfare of the patient always come first; therapists rarely ask for consideration of their interests in return. There are certain formal commitments and constraints in the professional psychotherapy relationship. Therapists and their patients agree to meet at designated times on a regular basis, and to continue meeting as long as doing so serves the patient’s interests. These meeting times are kept as free from interruption as the therapist is able to make them, and except for chance encounters, patient and therapist do not interact at other times or concerning matters other than a patient’s emotional difficulties. These arrangements put a single-minded stamp on professional psychotherapy that can rarely be maintained in other kinds of interpersonal relationships.

There is little evidence to suggest that any particular school, method, or modality of psychotherapy produces generally better results than any other. Individual patients may be more responsive to one type of psychotherapy than another as a function of their personality style, preferences, and degree of psychological-mindedness. Some patients may derive unique benefit from certain technical procedures as a function of their specific symptomatology. For example, cognitive-behavioral techniques have proven particularly effective in treating phobias, whereas psychodynamic interventions are the treatment of choice for many personality disorders.]

1. There is considerable evidence to indicate that the major approaches to psychotherapy are all beneficial and prove substantially more helpful to people with psychological problems than receiving no treatment or a placebo intervention. Not everyone is helped by psychotherapy, of course, and close to 10% of patients are found to deteriorate during the course of treatment. However, the data consistently show that the average person treated with psychotherapy is better off than 80% of no-treatment control participants in research studies, and patients who improve in psychotherapy tend to maintain their improvement for extended periods (Lambert, 2007; Lambert & Bergin, 1992; Lambert & Ogles, 2004; Lipsey & Wilson, 1993; Seligman, 1995). The general effectiveness of psychotherapy has been amply demonstrated for children and adolescents as well as for adults (Brems, 2004; Martin, D. G., 2002; Weisz & Hawley, 1998).
2. Psychotherapy works through the following modalities- by (1) relieving patients’ emotional distress, (2) assisting them in finding solutions to problems in their lives, and (3) helping them modify personality characteristics and behavior patterns that are preventing them from realizing their potential for productive work and rewarding interpersonal relationships. Increased self- understanding promoted by effective therapist communication is the means by which successful psychotherapy proceeds, but it is not a goal of the treatment. Insight in psychotherapy is merely the means to the end of improved adaptation, and insight in the absence of symptom relief and positive behavior change should not be considered a satisfactory treatment outcome (Bohart, 2007). Enhanced self-understanding without improved adaptation indicates that either (1) the insights achieved have not been relevant to the patient’s problems or (2) certain resistances to behavior.