Does psychotherapy work?

A review of the research

Definition

Efficacy:

A measure of the treatment’s ability to improve whatever condition it is indicated for.

Treatment efficacy (does it work?)

Historically, therapy efficacy was of little interest until the 1950's Freud rejected outcome research (problems

too heterogeneous -- "apples vs. oranges") Freud and contemporaries relied on case-

studies to illustrate techniques

Hans Eysenck’s 1952 “bombshell”

Methodology 19 peer-reviewed studies Outcome data for over 7000 neurotic patients 5 sets of psychoanalytic groups and 14 “eclectic” groups

Findings Spontaneous recovery rate =72% Psychoanalytic recovery rate=44% Eclectic recovery rate= 62%

But Eysenck's study met much criticism “Apples and oranges” No control groups Outcome criteria differences (when criteria restructured and

data reanalyzed:) Spontaneous remission =30% Psychoanalytic = 83% and eclectic = 65%

The ideal efficacy study

random assignment of patients to treatment and control groups treatment group no-treatment controls placebo controls

patients meet criteria for only one psychiatric diagnosis

treatments are manualized and scripted

patients are seen for a fixed number of sessions (usually 6-12)

outcome measures are unequivocal and quantifiable

raters and diagnosticians are blind (unknowledgeable) as to which group the patient is in

includes both post-treatment and follow-up assessment after a fixed period

Smith & Glass (1980)

Methodology: meta-analysis of  475 psychotherapy outcome studies

Findings: People in treatment function better than 80% of patients w/ no treatment (on waiting list)

Conclusions: Psychotherapy works There are negligible differences between different

types of therapy

Some more findings

Weisz, J. R., Weiss, B., Alicke, M. D., & Klotz, M. L. (1987). Effectiveness of psychotherapy with children and adolescents: a meta-analysis for clinicians. Journal of consulting and clinical psychology, 55(4), 542.

Lipsey, M. W., & Wilson, D. B. (1993). The efficacy of psychological, educational, and behavioral treatment: confirmation from meta-analysis. American psychologist, 48(12), 1181.

Efficacy vs. effectiveness

Efficacy: a measure of the treatment’s ability to improve whatever condition it is indicated for. Treatment carefully standardized Therapists highly trained Patients/clients carefully selected and randomly

assigned to treatment vs control group

Effectiveness: a measure of the how well the treatment works in the real world with all of its limitations. Patients may have multiple problems (comorbidity) Patients may receive multiple treatments at same time Treatments may vary as function of therapist of patient

characteristics, as well as insurance, time, etc.

Seligman’s 1995 Consumer Reports survey

Methodology 180,000 readers received issue w/survey 7,000 filled out survey, of which 3,000 saw mental

health professionals Respondents

educated middle class 50% female median age=46

Three outcome measures Specific Improvement Satisfaction Global Improvement

Findings Psychotherapy resulted in

improvement for majority (90%) of respondents

Psychiatrists, psychologists, and social workers all equally effective but better than marriage counselors (after controlling for severity and type of problem)

Seligman’s 1995 Consumer Reports survey

Consumer Reports Findings (cont.)

Longer treatment (i.e., more sessions) was related to more improvement

The 300-point scale is derived from 3 100-point sub-scales measuring specific improvement, satisfaction with therapist, and global improvement

Limitations on insurance coverage was associated with less improvement

Consumer Reports Findings (cont.)

People who reported feeling the worst prior to treatment, reported the most improvement

No difference between different types of therapies

No difference between psychotherapy alone and psychotherapy with meds

Active shoppers and active clients did better

Consumer Reports Findings (cont.)

Conclusion: Psychotherapy works!

Non-random, potentially biased sample

Cognitive dissonance may lead to positive bias in self reports

Improvement may be due to spontaneous remission or “regression to the mean”

Seligman’s 1995 Consumer Reports survey: A critique

10 major achievements of psychotherapy outcome research (Lambert & Bergin, 1992)

1. Psychotherapy generally has positive effects2. Many therapies > placebo3. Research now looks at specific types4. Behavior therapies effective for many disorders5. Cognitive therapy effective for depression6. Different types often equally effective7. Therapies have many factors in common8. Therapy may have negative effects 9. Brief therapy works for many (50%)10. Effects are relatively lasting

Is the Dodo bird extinct?

"Everybody has won, and all must have prizes."

Chapter 3 of Lewis Carroll's Alice's Adventures in Wonderland

Dodo bird effect (graphical form)(Wampold, 2001)

(NO significant differences among psychotherapies)

(significant differences among psychotherapies)