Are All Psychotherapies Equal?

Scientific American yesterday posted a nice summary of the research on effectiveness of psychotherapy.

From the article by Hal Arkowitz and Scott Lilienfeld:

In light of such findings, a search for a therapist should at least sometimes involve a consideration of the type of treatment he or she practices. It is true that ingredients, such as empathy, that cut across effective therapies are potent and that various established techniques are roughly equivalent for a broad range of difficulties. Yet under certain circumstances, the therapeutic method can matter. For example, if a clinician espouses an approach outside the scientific mainstream—one that does not fall under the broad categories we have listed here—you should not assume that this treatment will be as helpful as others.

One of the big puzzles of psychological treatment is why obviously unhelpful methods can lead clients to feel better. As noted in this article, some components of success cut across methods. A reparative therapist, for example, might explain a false set of facts to a client in an empathetic manner which might then provide a false sense of reassurance. Even though the therapy only minimally provides any effect on sexuality, the client may still feel better due to the working of the common factors.

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  • In a classic 1961 book the late psychiatrist Jerome Frank of the Johns Hopkins University argued that all effective therapies consist of clearly prescribed roles for healer and client. They present clients with a plausible theoretical rationale and provide them with specific therapeutic rituals, he wrote.

    Mental health treatment today is apparently in the same stage of development as physical health treatment was 5 centuries ago,

    What’s amazing is not the amount of hokum, superstition, and “things we know that just aren’t so”, but that lacking both a solid theory, and effective diagnostic tools, that a competent therapist is genuinely better than no therapy at all.

    Just as a competent 16th century surgeon could deal with a broken leg, even a compound fracture, and a Wise Woman knew that willowbark is a good febrifuge, we use various drugs, Lithium, Valium, Dextroamphetamine, SSRI and MAO inhibitors, but effective dose for individuals is guesswork, and it’s like trying to repair a cuckoo-clock when all you have are mallets of various sizes and weights,

    I’m torn between feeling like telling psychologists and psychiatrists that most of their theory is inconsistent rubbish, and being amazed at how well they do despite that. What is it, 30% improvement in outcome vs non-treatment?

    I think what helps most is having a friend. Someone who you can trust (just don’t study the theory of what they’re saying too hard), and who genuinely cares and is trying to help.

    Neuroscience will hopefully add a chisel, an awl, and one day finer and finer screwdrivers and rasps to our collection of mallets. That, and a jeweler’s loupe. What it can’t do is add the skill of a master craftsman, the difference between a mechanic and a healer.

  • ken

    For those of you who were wondering why the blog has been silent, Warren had a heart attack on Sunday and is having surgery today. More details at Byron’s Blog:

  • Sharon

    ken, thanks for posting that here — I’d wondered whether I should mention it or not.