Here’s a question that I – much to my surprise – never get asked by any of you:
“Does therapy actually work?”
There can be many reasons why you don’t ask me this. For example: you may have done some research yourself before you come and see me; you may have discussed it with your GP; you may figure that I’m the wrong person to ask as I’m hardly likely to say no; or you may be so distressed that you are willing to try anything to soothe the pain (history is full of desperate people buying snake oil in the hope that it would heal them).
Whatever the reason let me answer the question that you haven’t asked:
“Does psychotherapy actually make people better?”
Yes, the empirical evidence overwhelmingly shows that therapy is highly effective for a wide range of mental health problems.
So, given that psychotherapy works, the next logical question is:
“How does it work?”
Short answer: we don’t really know. The brain is a very complex organ.
To date there has been 20 studies using neuroimaging assessing brain changes following psychotherapy for depression. Together these studies suggest that psychotherapy alter brain function in people suffering major depression. We still don’t know the exact brain circuits involved but the prefrontal cortex and the amygdala have been suggested.
All right, so we know that psychotherapy work, we’re beginning to gain an understanding of the brain changes underlying this, another question that springs to mind is:
“Of the many various forms of therapy (e.g., cognitive behavioural, psychodynamic, interpersonal, dialectic behaviour therapy) which ones have been shown to be the most effective?
Well, that depends to some extend on the disorder but if we’re talking about depression a recent study compared the benefits of 7 different forms of psychotherapy and concluded that none were more effective than the others.
So, if it isn’t the actual form of therapy that predicts how well people are doing the question, of course, becomes:
“What predicts positive treatment outcome?”
The therapist. More specifically, how good is he or she at building, maintaining and enhancing the therapeutic relationship.
In summary, therapy works, it changes the brain, there is no difference between the various forms of therapy (at least for depression) and the crucial factor in successful therapy is the therapist.
Which makes me want to reiterate the last point of “Bad therapy”: be choosy and trust your gut feeling when picking a therapist (the person you’re working with is more important than their theoretical orientation).
So, rather than recommending a specific therapist or type of therapy (who may or may not suit their personality) pass on the above advice to anybody you know who’s contemplating commencing therapy – you’ll be doing them the favour of allowing them to trust their instinct.